Comment to Question 4

 

Conservative treatment, including immobilization and prolonged antibiotic therapy result in the resolution or clear improvement of spondylodiscitis in the majority of cases.
Early bed rest (for at least 10 days) is particularly important to avoid the weight of the upper part of the body being transmitted to the point of infection.
There is no absolute duration of therapy for infection, and optimal duration depends on several factors. Three to six weeks with a specific antibiotic is highly recommended, especially in immunocompromised patients. Longer therapy (12 weeks) may be necessary for patients with advanced disease manifested by extensive bone destruction and/or paravertebral infection.
Late complications are associated with short courses of i.v. antibiotics or with failure to remove the catheter. The administration of a long course of antibiotics is usually required in this clinical context.
Surgical debridement is only required in resistant cases. Acute onset of spinal cord signs constitutes a surgical emergency and requires immediate assessment for decompression in the case of epidural abscess. Other indications for surgery include progression of disease despite adequate directed or empiric antimicrobial therapy and threatened or actual cord compression due to vertebral collapse and/or spinal instability.
Needle biopsy is usually not necessary in patients with imaging test and clinical findings typical of vertebral osteomyelitis and positive blood cultures. If the cultures of blood and the needle aspirate are negative and the clinical suspicion for vertebral osteomyelitis remains high on the basis of clinical and imaging findings, we advocate initiating empiric therapy directed against common Gram-positive, (especially S. aureus), and Gram-negative bacterial pathogens.