Spondylodiscitis refers to infectious conditions affecting the vertebral column, and its incidence has steadily increased in recent decades. Imaging plays a crucial role at every stage of the disease. Radiological techniques are essential for (i) the initial diagnosis of spondylodiscitis, (ii) distinguishing it from other causes such as inflammatory, degenerative, or calcific disorders, (iii) assessing disease progression, and (iv) providing indications of the microorganisms involved. The latter can be achieved either through minimally invasive procedures (e.g., CT-guided biopsy) or inferred non-invasively by analyzing the features presented in CT, positron emission tomography (PET) CT, or MRI scans. This comprehensive review aims to outline the multimodal imaging characteristics of spondylodiscitis, serving as a reference for physicians, including infectious disease specialists, spine surgeons, and radiologists. Additionally, this review may offer insights for future research articles.

magnetic resonance imaging, multidetector computed tomography, image-guided biopsy, positron emission tomography computed tomography, spondylodiscitis

Grammatico L., Baron S., Rusch E., Lepage B., Surer N., Desenclos J.C., Besnier J.M. Epidemiology of vertebral osteomyelitis (VO) in France: Analysis of hospital-discharge data 2002–2003. Epidemiol. Infect. 2008;136:653–660. doi: 10.1017/S0950268807008850. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Chelsom J., Solberg C.O. Vertebral osteomyelitis at a Norwegian university hospital 1987–1997: Clinical features, laboratory findings and outcome. Scand. J. Infect. Dis. 1998;30:147–151. [PubMed] [Google Scholar]

Joughin E., McDougall C., Parfitt C., Yong-Hing K., Kirkaldy-Willis W.H. Causes and clinical management of vertebral osteomyelitis in Saskatchewan. Spine. 1991;16:261–264. doi: 10.1097/00007632-199103000-00002. [PubMed] [CrossRef] [Google Scholar]

Fantoni M., Trecarichi E.M., Rossi B., Mazzotta V., Di Giacomo G., Nasto L.A., Di Meco E., Pola E. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur. Rev. Med. Pharmacol. Sci. 2012;16((Suppl. S2)):2–7. [PubMed] [Google Scholar]

Son H.J., Kim M., Kim D.H., Kang C.N. Incidence and treatment trends of infectious spondylodiscitis in South Korea: A nationwide population-based study. PLoS ONE. 2023;18:e0287846. doi: 10.1371/journal.pone.0287846. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Govender S. Spinal infections. J. Bone Joint Surg Br. 2005;87:1454–1458. doi: 10.1302/0301-620X.87B11.16294. [PubMed] [CrossRef] [Google Scholar]

Nasto L.A., Colangelo D., Rossi B., Fantoni M., Pola E. Post-operative spondylodiscitis. Eur. Rev. Med. Pharmacol. Sci. 2012;16((Suppl. S2)):50–57. [PubMed] [Google Scholar]

Lang S., Walter N., Schindler M., Baertl S., Szymski D., Loibl M., Alt V., Rupp M. The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020. J. Clin. Med. 2023;12:3373. doi: 10.3390/jcm12103373. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Kramer A., Thavarajasingam S.G., Neuhoff J., Ponniah H.S., Ramsay D.S.C., Demetriades A.K., Davies B.M., Shiban E., Ringel F. Epidemiological trends of pyogenic spondylodiscitis in Germany: An EANS Spine Section Study. Sci. Rep. 2023;13:20225. doi: 10.1038/s41598-023-47341-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Pigrau C., Almirante B., Flores X., Falco V., Rodríguez D., Gasser I., Villanueva C., Pahissa A. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: Incidence, risk factors, and outcome. Am. J. Med. 2005;118 doi: 10.1016/j.amjmed.2005.02.027. [PubMed] [CrossRef] [Google Scholar]

Jimenez-Mejias M.E., de Dios Colmenero J., Sanchez-Lora F.J., Palomino-Nicás J., Reguera J.M., de la Heras J.G., García-Ordonez M.A., Pachon J. Postoperative spondylodiskitis: Etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin. Infect. Dis. 1999;29:339–345. doi: 10.1086/520212. [PubMed] [CrossRef] [Google Scholar]

Gentile L., Benazzo F., De Rosa F., Boriani S., Dallagiacoma G., Franceschetti G., Gaeta M., Cuzzocrea F. A systematic review: Characteristics, complications and treatment of spondylodiscitis. Eur. Rev. Med. Pharmacol. Sci. 2019;23((Suppl. S2)):117–128. [PubMed] [Google Scholar]

Sato K., Yamada K., Yokosuka K., Yoshida T., Goto M., Matsubara T., Iwahashi S., Shimazaki T., Nagata K., Shiba N., et al. Pyogenic Spondylitis: Clinical Features, Diagnosis and Treatment. Kurume Med. J. 2019;65:83–89. doi: 10.2739/kurumemedj.MS653001. [PubMed] [CrossRef] [Google Scholar]

Asperges E., Albi G., Truffelli F., Salvaderi A., Puci F., Sangani A., Zuccaro V., Scotti V., Orsolini P., Brunetti E., et al. Fungal Osteomyelitis: A Systematic Review of Reported Cases. Microorganisms. 2023;11:1828. doi: 10.3390/microorganisms11071828. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Koutserimpas C., Chamakioti I., Naoum S., Raptis K., Alpantaki K., Kofteridis D.P., Samonis G. Spondylodiscitis Caused by Aspergillus Species. Diagnostics. 2021;11:1899. doi: 10.3390/diagnostics11101899. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Petkova A.S., Zhelyazkov C.B., Kitov B.D. Spontaneous Spondylodiscitis—Epidemiology, Clinical Features, Diagnosis and Treatment. Folia Med. 2017;59:254–260. doi: 10.1515/folmed-2017-0024. [PubMed] [CrossRef] [Google Scholar]

Pola E., Taccari F., Autore G., Giovannenze F., Pambianco V., Cauda R., Maccauro G., Fantoni M. Multidisciplinary management of pyogenic spondylodiscitis: Epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients. Eur. Spine J. 2018;27((Suppl. S2)):229–236. doi: 10.1007/s00586-018-5598-9. [PubMed] [CrossRef] [Google Scholar]

Shanmuganathan R., Ramachandran K., Shetty A.P., Kanna R.M. Active tuberculosis of spine: Current updates. N. Am. Spine Soc. J. 2023;16:100267. doi: 10.1016/j.xnsj.2023.100267. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Hopkinson N., Stevenson J., Benjamin S. A case ascertainment study of septic discitis: Clinical, microbiological and radiological features. QJM. 2001;94:465–470. doi: 10.1093/qjmed/94.9.465. [PubMed] [CrossRef] [Google Scholar]

Cottle L., Riordan T. Infectious spondylodiscitis. J. Infect. 2008;56:401–412. doi: 10.1016/j.jinf.2008.02.005. [PubMed] [CrossRef] [Google Scholar]