Conservative versus surgical treatment of spondylodiscitis

  • Aristeides Koutsopoulos
  • Ioannis S. Benetos
  • Ioannis Vlamis
  • Spyridon G. Pneumaticos
Keywords: spondylodiscitis ; vertebral osteomyelitis; spinal infection; treatment; Management


Early diagnosis and aggressive initial treatment are essential for a satisfactory outcome of patients with spondylodiscitis. However, management strategies are still controversial. Aiming to compare the results of conservative and surgical treatment of patients with spondylodiscitis, a review of the current literature was conducted by using the online Pubmed database and the following keywords: (“treatment” OR “management” OR “therapy”) AND (“vertebral osteomyelitis” OR “spondylodiscitis” OR “spinal infection” OR “discitis”). The search included only comparative prospective or retrospective studies, comparing conservative versus surgical management, in terms of outcome and complications. Initially, 407 studies were identified after a primary search on the online Pubmed database. Finally, 14 studies were included in the review (12 retrospective and 2 prospective studies). In conclusion, the initial treatment of spondylodiscitis should be conservative with bed rest, bracing and proper antibiotic treatment lasting for at least 8 weeks. However, in cases of neurological deficit, abscess formation, deformities and failure of conservative management, surgical treatment is required. Although conservative treatment is associated with a higher rate of chronic back pain and long-term deformities, it is also associated with a lower mortality rate in comparison to surgical management. Perioperative complications still remain an issue in surgically treated patients; however, patients’ satisfaction and quality of life are higher compared to those of conservatively treated patients, indicating that treatment of spondylodiscitis should be individualized taking into consideration patients’ clinical presentation, imaging studies and the virulence of the responsible pathogen.


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Author Biographies

Aristeides Koutsopoulos

3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece

Ioannis S. Benetos

3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece

Ioannis Vlamis

3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece

Spyridon G. Pneumaticos

3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece


1. Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3(1):5-16.
2. Asamoto S, Doi H, Kobayashi N, Endoh T, Sakagawa H, Iwanaga Y, et al. Spondylodiscitis: diagnosis and treatment. Surg Neurol. 2005 Aug;64(2):103-108; discussion 108.
3. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008 Jun;56(6):401-412.
4. Gentile L, Benazzo F, De Rosa F, Boriani S, Dallagiacoma G, Franceschetti G, et al. A systematic review: characteristics, complications and treatment of spondylodiscitis. Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):117-128.
5. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010 Nov;65 Suppl 3:iii11-24.
6. Zarghooni K, Röllinghoff M, Sobottke R, Eysel P. Treatment of spondylodiscitis. Int Orthop. 2012 Feb;36(2):405-411.
7. Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop. 2012 Feb;36(2):413-420.
8. Nickerson EK, Sinha R. Vertebral osteomyelitis in adults: an update. Br Med Bull. 2016 Mar;117(1):121-138.
9. Karadimas EJ, Bunger C, Lindblad BE, Hansen ES, Hoy K, Helmig P, et al. Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop. 2008 Oct;79(5):650-659.
10. Valancius K, Hansen ES, Høy K, Helmig P, Niedermann B, Bünger C. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J. 2013 Aug;22(8):1837-1844.
11. Nasto LA, Colangelo D, Mazzotta V, Di Meco E, Neri V, Nasto RA, et al. Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis. Spine J. 2014 Jul 1;14(7):1139-1146.
12. Wirtz DC, Genius I, Wildberger JE, Adam G, Zilkens KW, Niethard FU. Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis--an evaluation of 59 cases. Arch Orthop Trauma Surg. 2000;120(5-6):245-251.
13. Alas H, Fernando H, Baker JF, Brown AE, Bortz C, Naessig S, et al. Comparative outcomes of operative relative to medical management of spondylodiscitis accounting for frailty status at presentation. J Clin Neurosci. 2020 May;75:134-138.
14. Waheed G, Soliman MAR, Ali AM, Aly MH. Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients. Neurosurg Focus. 2019 Jan 1;46(1):E10.
15. Behmanesh B, Gessler F, Duetzmann S, Seifert V, Weise L, Setzer M. Quality of Life Following Surgical and Conservative Therapy of Pyogenic Spinal Infection: A Study of Long-term Outcome in 210 Patients. J Neurol Surg A Cent Eur Neurosurg. 2021 Mar 9.
16. Woertgen C, Rothoerl RD, Englert C, Neumann C. Pyogenic spinal infections and outcome according to the 36-item short form health survey. J Neurosurg Spine. 2006 Jun;4(6):441-446.
17. Canouï E, Zarrouk V, Canouï-Poitrine F, Desmoulin U, Leflon V, Allaham W, et al. Surgery is safe and effective when indicated in the acute phase of hematogenous pyogenic vertebral osteomyelitis. Infect Dis (Lond). 2019 Apr;51(4):268-276.
18. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976). 2000 Jul 1;25(13):1668-1679.
19. Park KH, Chong YP, Kim SH, Lee SO, Choi SH, Lee MS, et al. Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus. J Infect. 2013 Dec;67(6):556-564.
20. Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997 Dec;56(12):709-715.
21. Sobottke R, Zarghooni K, Krengel M, Delank S, Seifert H, Fätkenheuer G, et al. Treatment of spondylodiscitis in human immunodeficiency virus-infected patients: a comparison of conservative and operative therapy. Spine (Phila Pa 1976). 2009 Jun 1;34(13):E452-458.
22. Sobottke R, Röllinghoff M, Zarghooni K, Schlüter-Brust K, Delank KS, Seifert H, et al. Spondylodiscitis in the elderly patient: clinical mid-term results and quality of life. Arch Orthop Trauma Surg. 2010 Sep;130(9):1083-1091.