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Diagnosing infectious spondylodiscitis is challenging due to inconsistent guidelines for imaging and biopsy. Harmonizing these recommendations is crucial for improving diagnostic accuracy and patient outcomes in this serious spinal infection.

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Area of Science:

  • Radiology
  • Infectious Diseases
  • Spine Surgery

Background:

  • Infectious spondylodiscitis diagnosis is complex, with nonspecific symptoms and varied diagnostic pathways.
  • Current international guidelines offer divergent recommendations for imaging, biopsy, and molecular diagnostics.

Purpose of the Study:

  • To compare major international guidelines for infectious spondylodiscitis diagnosis.
  • To identify areas of agreement and disagreement in diagnostic strategies, focusing on imaging, microbiology, and follow-up.

Main Methods:

  • Comparative review of key international guidelines (IDSA, EANM/ESNR/ESCMID, S2k, ACR, SPILF, EANS).
  • Analysis focused on imaging algorithms, microbiologic confirmation, and follow-up assessment.

Main Results:

  • Substantial heterogeneity exists in MRI, CT, and PET/CT indications, biopsy timing, and molecular diagnostic use.
  • While MRI and image-guided biopsy are emphasized, gaps remain in whole-spine imaging, antibiotic washout, and specimen handling.

Conclusions:

  • Discrepancies in current guidelines necessitate unified, multidisciplinary, evidence-based recommendations for spondylodiscitis diagnosis.
  • Harmonizing diagnostic pathways may improve diagnostic yield, reduce delays, and standardize imaging strategies.