Spondylodiscitis / Spinal Infection Treatment

What is Spondylodiscitis?

Spondylodiscitis is an infection of the intervertebral disc (discitis) and adjacent vertebral bodies (osteomyelitis). It is a serious condition requiring urgent specialist management. If untreated, it can lead to vertebral destruction, spinal deformity, epidural abscess formation, and potentially catastrophic neurological injury from spinal cord compression.

In India, spinal tuberculosis (Pott's disease) is the most common form of spinal infection, accounting for approximately 1% of all tuberculosis cases. Pyogenic (bacterial) spondylodiscitis is increasingly common in immunocompromised patients, diabetics, and intravenous drug users.

Urgent: Spinal infection with neurological symptoms requires emergency surgical evaluation. Epidural abscess causing paralysis is a surgical emergency — hours matter.

Symptoms

Severe back or neck pain, often worse at night

Fever, chills, and night sweats (systemic infection)

Point tenderness over the infected vertebra

Unexplained weight loss (TB)

Progressive leg weakness or paralysis

Psoas abscess — visible swelling or groin pain

Types of Spinal Infection

TB Spondylitis (Pott's Disease) — Mycobacterium tuberculosis; typically affects thoracic spine; kyphosis ("gibbus") deformity
Pyogenic Spondylodiscitis — bacterial (Staphylococcus, Streptococcus, E. coli); often haematogenous spread
Epidural Abscess — pus collection compressing the spinal cord; surgical emergency
Fungal Spondylitis — rare; Candida or Aspergillus in immunocompromised patients

Diagnosis

MRI with gadolinium — most sensitive; shows disc and vertebral involvement, abscess, cord compression
Blood cultures — identify causative organism
CT-guided biopsy — definitive microbiological diagnosis
Blood tests: CRP, ESR, WBC, Procalcitonin
TB workup: IGRA, sputum culture, chest X-ray

Treatment

Antibiotic / Anti-TB Therapy

Culture-guided IV antibiotics for 4–6 weeks followed by oral. TB: standard 9–12 month ATT regimen. Brace for vertebral support during healing.

CT-Guided Drainage

Percutaneous aspiration or drainage of paraspinal or psoas abscess under CT guidance — minimally invasive definitive treatment for many cases.

Surgical Debridement + Fusion

Indicated for neurological deficit, spinal instability, progressive deformity, or failure of conservative treatment. Removes infected tissue and stabilises the spine.

Emergency Cord Decompression

For epidural abscess with neurological compromise — emergency surgical decompression to prevent permanent paralysis. Results are best when performed urgently.

Spondylodiscitis & Spinal Infection