Current concepts in the diagnosis and management of pyogenic spondylodiscitis

Abstract

Background. Pyogenic spondylodiscitis (PSD) is a severe spinal infection associated with significant morbidity, mortality, and diagnostic challenges due to its frequently nonspecific clinical presentation. The increasing incidence observed in elderly and immunocompromised patients, together with the growing number of spinal procedures, has renewed interest in optimizing diagnostic and therapeutic strategies. Objective. To provide an updated overview of the diagnosis, treatment, and monitoring of PSD. Methods. A narrative review of the literature was performed using major biomedical databases and relevant scientific publications published between 2006 and 2026. Relevant evidence regarding microbiological diagnosis of PSD, imaging, antimicrobial therapy, surgical management, and follow-up was analyzed and synthesized. Results. Magnetic resonance imaging (MRI) remains the imaging technique of choice for the diagnosis of PSD, while microbiological identification through cultures and molecular methods is essential for targeted treatment. Recent evidence supports shorter antibiotic regimens, with early transition to oral therapy in selected patients. Novel antimicrobial agents and anti-biofilm strategies have expanded treatment options for resistant and implant-associated infections. Surgical intervention remains necessary in cases of PSD associated with neurological deficits, spinal instability, abscess formation, or failure of conservative management. Conclusions. The management of PSD requires a multidisciplinary and individualized approach integrating early diagnosis, accurate microbiological identification, targeted antimicrobial therapy, and timely surgical intervention when indicated.