Surgical Management of Spondylodiscitis: A Single-Center Retrospective Analysis of 126 Cases

Introduction/background: Pyogenic spondylodiscitis is a serious spinal infection. Surgical debridement with or without stabilization is an established adjunct to antibiotic therapy, yet indication criteria and operative extent vary across the literature. We evaluated outcomes of surgically treated spondylodiscitis at our institution (2015–2024). Methods We retrospectively analyzed consecutive patients indicated for surgery. Variables included procedure type (decompression alone vs. instrumentation), presence of epidural abscess, reoperation for relapse or new-onset instability, microbiology, length of hospital stay (LOS), early outcomes, and admission clinical status. Results We identified 126 patients (87 men, 69%); mean age 65 years (range 13–91). Surgery was performed in 108 patients: decompression alone in 76 (70.4%), instrumented decompression in 21 (19.4%), standalone instrumentation in 4 (3.7%), and multistage combined procedures in 7 (6.5%). An epidural abscess was present at the index operation in 98/108 (90.7%), confirmed intraoperatively or on preoperative MRI. Disease relapse occurred in 23.1%; reoperation for progressive instability in 15.7%. The most common pathogen was Staphylococcus aureus (55%), followed by streptococci (11%) and Enterobacterales (14%). Mean LOS was 35.3 days (median 27). Multiorgan failure developed in 44 patients (35%). Seven patients died. No implant-related complications were observed. Conclusions In most operated cases, early surgical source control with decompression without instrumentation was sufficient. When instability is demonstrated, instrumentation is safe even in active infection provided meticulous debridement and targeted antibiotic therapy are employed. The high diagnostic yield of blood cultures and tissue samples supports early acquisition and repetition as needed.