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2026, Number 2

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Cir Columna 2026; 4 (2)

Spondylodiscitis: current concepts in diagnosis, management, and surgical indications

Márquez CCJ, Méndez CEA, Estrella OE, Tovar LJ

Language: Spanish
References: 24
Page: 116-125
PDF size: 276.28 Kb.


ABSTRACT

Spondylodiscitis is the infection of the intervertebral disc and adjacent vertebrae, being the most common infection in the spine and the third most frequent cause of osteomyelitis. It predominantly affects individuals over 50 years old, especially men, with risk factors such as diabetes, immunosuppression, and intravenous drug use. The most common etiological agent is Staphylococcus aureus. Clinical presentation includes persistent pain with or without neurological deficit, fever in less than half of the cases, and elevated inflammatory markers such as C-reactive protein (CRP). Diagnosis is often delayed from two to six months due to nonspecific symptoms and low sensitivity of initial radiographs; magnetic resonance imaging (MRI) is the gold standard with high sensitivity and specificity to detect infection and its complications. Microbiological diagnosis is made through blood cultures, cultures of probable infectious foci, percutaneous or surgical biopsies, although the causative agent fails to be identified in up to one-third of cases. Treatment is based on prolonged antibiotics and spinal stabilization. Empirical therapy should cover resistant Staphylococcus and gram-negative bacteria, preferably with vancomycin and third- or fourth-generation cephalosporins, starting after cultures are obtained, except in patients with progressive neurological symptoms or sepsis, in whom treatment is started immediately. The optimal duration is generally six weeks, extending up to 12 weeks based on comorbidities or even longer for specific agents (Brucella, tuberculosis), aiming to reduce hospital stays and prolonged bed rest whenever possible. Surgery is reserved for patients with spinal instability, neurological compromise, or abscesses; with decompression, early stabilization, and debridement as foundations. Several severity classifications based on clinical and radiographic findings (Pola, SSC, BSDS) guide surgical decision-making. Clinical follow-up is done with CRP and clinical evaluation up to 2-4 weeks after antibiotic therapy, since MRI images may remain altered after clinical resolution. Overall mortality is low, but complications and relapses can occur, especially in patients with risk factors. The need for standardized protocols and prospective multicenter studies to improve disease management and prognosis is emphasized.


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