Spinal infections: evolving concepts

Purpose of review Although rare, spinal infections are characterized by an indolent clinical course and delay in diagnosis. Physicians should be aware of current diagnostic and therapeutic developments. Recent findings The range of the pathogens causing spinal infections has expanded as a result of the increasing number of individuals at risk and enhanced diagnostics. The role of newer biological therapies in producing spinal infections has not been elucidated yet. Pyogenic bacteria still account for most of the cases; however, tuberculosis and brucellosis remain major causes in endemic countries and susceptible patients. Endoscopic techniques assist in sampling suspicious lesions and molecular microbiology has revolutionized diagnosis. Magnetic resonance imaging techniques remain the gold standard for diagnostic imaging; their role in follow-up is a matter of debate. Long-term antimicrobial treatment is currently the standard of care. The identification of individuals most likely to benefit from surgical intervention is crucial. Surgery may be required early to address any neurological deficits and later to treat infection refractory to conservative treatment. Summary Prompt diagnosis is essential in spinal infections. Early surgical intervention is required in patients with neurological deficits. Further research should clarify the appropriate duration of antimicrobial treatment and the overall role of surgery.