Diagnostic and Management Strategies for Spinal Infections

Spinal infections encompass a spectrum of conditions affecting the vertebral bodies, intervertebral discs and adjacent soft tissues, presenting a growing clinical challenge worldwide. Early recognition is often delayed owing to non‐specific symptoms and overlap with degenerative, inflammatory or neoplastic spinal disorders. Diagnostic pathways integrate clinical assessment with laboratory markers of inflammation and advanced imaging, with magnetic resonance imaging (MRI) regarded as the gold standard for detecting marrow oedema, epidural extension and abscess formation. Microbiological confirmation via blood cultures or image-guided and open biopsies informs targeted antimicrobial therapy, although culture yields may be compromised by prior antibiotic exposure. Management hinges on a multidisciplinary approach: prolonged intravenous followed by oral antibiotic regimens tailored to pathogen sensitivities are indicated for the majority of patients, while surgical intervention is reserved for those with neurological deficits, spinal instability, extensive abscesses or failure of conservative measures. Surgical goals include debridement, abscess drainage, neural decompression and restoration of spinal alignment, increasingly achieved through minimally invasive and image-guided techniques. Despite advances in diagnostics and therapeutics, optimal treatment algorithms remain to be defined by prospective studies that balance efficacy, patient comorbidities and the risks of recurrence.

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Diagnostic and Management Strategies for Spinal Infections publication trend

The graph below shows the total number of articles in diagnostic and management strategies for spinal infections across all publications each year (not limited to Nature Index journals).

Technical terms

Spondylodiscitis: Infection of the vertebral bodies and intervertebral discs.

Magnetic resonance imaging (MRI): Non-invasive imaging modality using magnetic fields and radiofrequency pulses to visualise soft-tissue and marrow abnormalities.

Negative-pressure wound therapy (NPWT): A method applying controlled suction to a wound or abscess cavity to facilitate drainage, perfusion and immune cell activity.

Paraspinal abscess: A localized collection of pus adjacent to the spinal column, often requiring surgical or percutaneous drainage.

Hematogenous spread: Dissemination of pathogens via the bloodstream to distant sites, including spinal structures.

References

1. Case Report: A spinal infection with bilateral psoas abscesses was treated with NPWT to enhance the local infection by increasing the infiltration of neutrophil cells and draining the pus. Frontiers in Cellular and Infection Microbiology (2023).
2. Antimicrobial Treatment Challenges in the Management of Infective Spondylodiscitis Associated with Hemodialysis: A Comprehensive Review of Literature and Case Series Analysis. Antibiotics (2024).
3. Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study. Epidemiology and Infection (2021).