Medical and surgical management of non- pyogenic spontaneous spondylodiscitis

Non-pyogenic spontaneous spondylodiscitis, although most commonly casued by tuberculosis, can be caused by brucellosis and a variety of fungi including aspergillus, coccidioides and candida. Direct aspiration or tissue biopsy is usually necessary to identify the causative organism. An appropriate antibiotic treatment for the likely offending organism is proposed. Surgical treatment is reserved for unstable spinal segment or marked kyphosis in the face of any neurologic deficit. Surgical approaches are dictated by the anatomic location of the offendnig lesion

Treatment of spontaneous and post-operative pyogenic spondylodiscitis

Spinal infection is an uncommon but important clinical problem that often requires aggressive medical and surgical management. If recognized early and treated appropriately, a full recovery can often be expected. Treatment and outcome of spontaneous and postoperative pyogenic spondylodiscitis are discussed. The principles of conservative treatment are to establish accurate microbiological diagnosis, treat with specific antibiotics, immobilise the spine and carefully monitor for spinal instability and neurological deterioration. The principles of surgical treatment are to obtain multiple intraoperative cultures of bone and soft tissue, perform a through debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft +/- concomitant instrumentation