Abstract

Introduction

The management of pyogenic spondylodiscitis (PS) remains challenging due to the absence of clear, evidence-based guidelines. This study aimed to assess the clinical characteristics, diagnostic and follow-up challenges, and treatment outcomes of patients with PS.

Materials and Methods

The clinical, laboratory, and radiological data of all patients aged ≥18 years who were hospitalized with PS between January 2015 and June 2024 were retrospectively analyzed.

Results

Among 25 patients diagnosed with PS, 60% were male, with a mean age of 61 ± 10.6 years (range: 41–78). The most common symptoms were back or neck pain (88%), difficulty walking (24%), and fever (20%). The mean symptom duration was 2 months. The lumbosacral (60%), thoracic (44%), and cervical (12%) regions were the most frequently affected. A total of 84% of patients had at least one comorbidity, and 80% had a predisposing risk factor. Blood cultures were positive in 60% of patients. Among the 23 patients who underwent tissue and/or abscess culture, 43.7% and 30% yielded positive results, respectively. The most frequently isolated pathogen was methicillin-susceptible Staphylococcus aureus (MSSA) (48%). Among patients followed with contrast-enhanced magnetic resonance imaging (MRI), 41.2% demonstrated persistent contrast enhancement without significant change. The total treatment duration was 12 ± 4.1 weeks (range: 7–24). Treatment success was achieved in 86.3% of cases, while 3 (13.6%) patients experienced recurrence. In all recurrent cases, S. aureus was the causative agent, and paraspinal abscess and bacteremia were present concomitantly. All recurrent cases had received at least 12 weeks of pathogen-targeted therapy.

Conclusion

Hospitalization and invasive procedures appear to be significant risk factors for PS. Obtaining blood and tissue/abscess cultures before initiating antimicrobial therapy enhances the likelihood of pathogen identification. Despite adequate treatment, MRI findings may persist without complete radiological resolution. Close monitoring is warranted for potential recurrence when S. aureus is the causative pathogen, especially in the presence of abscess or bacteremia.