Epidemiology and management of infectious spondylitis in Korea: a narrative review

Infectious spondylitis, an infection of the vertebral body, intervertebral disc, or paraspinal tissues, poses diagnostic and therapeutic challenges. This review examines the clinical approach and management of infectious spondylitis in Korea. The incidence of pyogenic spondylitis has increased, primarily due to the aging population, more frequent use of invasive procedures, and higher prevalence of immunocompromising conditions. Conversely, tuberculous spondylitis has declined, reflecting shifts in population demographics and medical practices. Staphylococcus aureus remains the predominant causative agent in pyogenic cases, while Mycobacterium tuberculosis is the primary pathogen in tuberculous spondylitis. The diagnosis is contingent upon clinical suspicion, inflammatory markers, imaging studies, and microbiological identification. MRI is the preferred imaging modality, offering high sensitivity and specificity. Blood cultures and tissue biopsy are instrumental in isolating the causative organism and determining its antibiotic susceptibility. Treatment involves antimicrobial therapy, spinal immobilization, and vigilant monitoring for complications. Surgical intervention may be necessary in cases involving neurological deficits, abscesses, or spinal instability. The prognosis for infectious spondylitis varies. Long-term complications, including chronic pain, neurological deficits, and spinal deformities, may arise and can meaningfully impact quality of life. Mortality is considerable and is influenced by comorbidities and disease severity. The risk of recurrence, particularly within the first year after treatment, is a concern. This review underscores the importance of ongoing research and education in refining diagnostic and treatment strategies for infectious spondylitis. As this condition becomes more common, these efforts offer hope for improving patient care and reducing the burden of this severe spinal infection.