Clinical and radiological features of infectious spondylodiscitis in an Italian cohort: a retrospective study

Infectious spondylodiscitis (IS) is a rare spinal infection that affects the vertebrae, intervertebral discs, and adjacent structures. Despite many advances, delays in diagnosis and treatment remain prevalent. The primary objective of this retrospective observational study was to improve clinical outcomes, support differential diagnosis, and provide guidance for management when the identification of a pathogen is not feasible.

A comprehensive investigation was conducted to examine clinical, radiological, and laboratory characteristics of patients diagnosed with microbiologically confirmed spondylodiscitis.

A total of 70 patients diagnosed with infectious spondylodiscitis (IS) were enrolled over a period of 12 years (2013-2025). Patients were stratified into two groups: a) IS with an identified pathogen and b) IS with unknown etiology. The first group comprised 43 patients in whom the pathogen was identified through a blood culture or tissue biopsies (61.4%). These patients experienced a higher frequency of concurrent involvement of multiple spinal sites(p = 0.0196), a considerably prolonged hospital stay (p = 0.0355) and more severe baseline pain (p = 0.0256) in comparison with IS with unknown etiology. Additionally, the presence of infection in several sites were found to be associated with an increased probability to identify the causative pathogen (p = 0.0354).The early and accurate diagnosis of the condition is crucial, and this can be facilitated using clinical, laboratory, and imaging parameters, especially magnetic resonance imaging (MRI). The integration of clinical parameters with pain assessment has the potential to facilitate clinical prediction, inform invasive diagnostic decisions, and enhance treatment response monitoring.