Surgical Management of Spondylodiscitis: A Single-Center Retrospective Analysis of 126 Cases

Pyogenic spondylodiscitis is a severe spinal infection. Surgery can provide source control, neural decompression, and stability when indicated, but practice varies. We assessed outcomes of surgically treated cases at a tertiary neurosurgical center (2015-2024).

Retrospective cohort of consecutive adults admitted with pyogenic spondylodiscitis to a tertiary neurosurgical center (2015-2024). Surgical and non-surgical cases were recorded; analyses focus on surgically managed patients with whole-cohort descriptors where indicated.

We retrospectively analysed consecutive patients indicated for surgery. Variables included procedure type (decompression alone vs. instrumentation), presence of epidural abscess, reoperation for relapse or new-onset instability, microbiology, length of hospital stay (LOS), early outcomes, and admission clinical status.

We included 126 patients (87 men, 69%); mean age 65 years (range 13-91). Surgery was performed in 108 (85.7%): decompression alone in 76/108 (70.4%), instrumented decompression in 21/108 (19.4%), standalone instrumentation in 4/108 (3.7%), and multistage combined procedures in 7/108 (6.5%). Epidural abscess was present at the index operation in 98/108 (90.7%). Relapse, either confirmed intraoperatively or on preoperative MRI occurred in 29/126 (23.0%); reoperation for progressive instability in 17/108 (15.7%). Among patients with confirmed etiology (121/126, 96.0%), the most frequent pathogens were Staphylococcus aureus 69/121 (57.0%), Enterobacterales 18/121 (14.9%), and streptococci 16/121 (13.2%). Mean LOS was 35.3 days (median 27). Multiorgan failure developed in 44/126 (35.0%); in-hospital mortality was 7/126 (5.6%). No implant-related complications were observed.

Early surgical source control with decompression without instrumentation was sufficient in most operated cases. When radiographic or intraoperative instability was present, instrumentation appeared safe despite active infection, provided meticulous debridement and pathogen-directed antibiotics were employed. Blood cultures and tissue samples should be taken timely and repeated if needed, as they both provide high diagnostic yield.