Management of Pyogenic Spondylodiscitis: Conservative and Surgical Treatment Strategies

Abstract

Background: Pyogenic spondylodiscitis requires treatment directed toward infection eradication, preservation or restoration of spinal stability, neurological preservation or recovery, and pain relief. Conservative treatment is the first-line approach for uncomplicated disease without neurological deficit, severe instability, or large epidural abscesses, while surgical treatment is indicated in complicated disease and when conservative management fails.

 Objective: To review the conservative and surgical management of pyogenic spondylodiscitis, including spinal immobilization, antibiotic therapy, surgical indications and timing, regional surgical approaches, minimally invasive techniques, instrumentation in infection, prognosis, and the evidence-based treatment algorithm presented in the thesis.

Conclusion: Management should be selected according to disease severity. Conservative treatment is appropriate for uncomplicated pyogenic spondylodiscitis, whereas progressive neurological deficit, septicemia, epidural abscess with neurological compromise, instability, significant deformity, large abscess, or failure of conservative treatment support surgical intervention. The available evidence favors an individualized treatment algorithm, while the optimal surgical technique remains controversial.