Treatment of Spondylodiscitis

Introduction to Treatment

The American College of Physicians recommends initiating treatment with empirical antibiotic therapy that includes vancomycin combined with a third- or fourth-generation cephalosporin or a carbapenem, followed by adjustment based on culture results, with a total duration of 6-12 weeks, supplemented with surgery when neurological deficits or spinal instability exist 1

The Infectious Diseases Society of America suggests that biopsy-guided or surgical biopsy has a higher diagnostic yield than blood cultures for bacterias 1

The American College of Physicians recommends vancomycin (15-20 mg/kg IV every 12 hours) combined with one of the following options: cefepime (2 g IV every 8-12 hours), carbapenem: meropenem (1 g IV every 8 hours), imipenem-cilastatin (500 mg IV every 6 hours), or ertapenem (1 g IV every 24 hours), or ceftriaxone (2 g IV every 24 hours) + metronidazole (500 mg IV every 8 hours) 1

The Infectious Diseases Society of America recommends administering initial parenteral therapy for 2-4 weeks, followed by oral antibiotics to complete 6-12 weeks of total treatment 1
A randomized clinical trial demonstrated that 6 weeks of total treatment is not inferior to 12 weeks, with clinical cure rates of 90.9% in both groups 1

The North American Spine Society indicates that surgical intervention is indicated in cases of neurological deficits with spinal cord compression, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief, unreliable identification of the pathogen requiring debridement for sampling, or spinal instability 2

The American College of Physicians recommends monitoring VSG and PCR as primary means to evaluate treatment response 1, 2
The European Journal of Nuclear Medicine and Molecular Imaging suggests that MRI with and without contrast is the primary diagnostic modality, with a sensitivity of 96%, specificity of 94%, and accuracy of 92% 3, 2
The European Journal of Nuclear Medicine and Molecular Imaging recommends PET/CT with [18F]FDG as the preferred modality for detection within the first 14 days of symptom onset 4, 3

The American College of Physicians notes that approximately 10% of cases may present with non-contiguous multilevel infections, which should be considered in diagnostic evaluation and follow-up 1, 3, 2
The European Journal of Nuclear Medicine and Molecular Imaging reports that infection of a single level occurs in 65% of patients, while contiguous multilevel infection occurs in approximately 20% 4, 5