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Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 14377

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Special Issue Editor

Dr. Kalliopi Alpantaki

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Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Crete, 71409 Heraklion, Greece
Interests: spinal surgery; trauma; biomaterials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Τhe field of spinal infections constitutes a demanding diagnostic and management problem for which multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Patients expect not only pain alleviation but also rapid recovery of function. Spinal infections can be classified by the anatomical location involved: the vertebral body, the intervertebral disc space, and the spinal canal. Infections are usually caused by bacteria although fungal infections may also occur. Spinal infections can be primary typically through hematogenous spread of the microorganism from a distant infected area or can occur after surgery. Adults are affected far more often, while the incidence of spinal infection in patients less than 20 years old in developed countries is 0.3/100,000.

The current standard of care involves aggressive, prolonged antibiotic administration with or without surgical debridement of the infected tissues. Although traditional treatment may be sufficient for managing a portion of cases, recurrences of the infection and associated risks including pain, spinal instability, neurological impairment, and toxicity with long‐term antibiotic usage have been reported.

Among the pertinent practical open questions in the field of spinal infections are the benefits of spinal instrumentation, the role of emerging technologies in diagnosis and treatment, such as minimal invasive surgery, the design of novel implants and smart materials, and the optimization of antibiotic treatment.

The aim of this Special Issue, therefore, is to provide a stage for outstanding clinical, technical, and epidemiological contributions describing recent advances that can lead to improvements of diagnosis, treatment, and prognosis in the field of spinal infections.

Dr. Kalliopi Alpantaki
Guest Editor

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Keywords

spinal infection
bacteria spine
spondylodiscitis
vertebral infection
lumbar infection
thoracic infection
sacral infection
cervical infection
disc infection

Published Papers (10 papers)

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Research

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11 pages, 1472 KiB

Open AccessArticle

Anterior Column Reconstruction of Destructive Vertebral Osteomyelitis at the Thoracolumbar Spine with an Expandable Vertebral Body Replacement Implant: A Retrospective, Monocentric Radiological Cohort Analysis of 24 Cases

by Lisa Klute, Marie Esser, Leopold Henssler, Moritz Riedl, Melanie Schindler, Markus Rupp, Volker Alt, Maximilian Kerschbaum and Siegmund Lang

J. Clin. Med. 2024, 13(1), 296; https://doi.org/10.3390/jcm13010296 - 4 Jan 2024

Viewed by 790

Abstract

Background: Vertebral osteomyelitis (VO) often necessitates surgical intervention due to bone loss-induced spinal instability. Anterior column reconstruction, utilizing expandable vertebral body replacement (VBR) implants, is a recognized approach to restore stability and prevent neurological compromise. Despite various techniques, clinical evidence regarding the safety and efficacy of these implants in VO remains limited. Methods: A retrospective cohort analysis, spanning 2000 to 2020, was conducted on 24 destructive VO cases at a Level 1 orthopedic trauma center. Diagnosis relied on clinical, radiological, and microbiological criteria. Patient demographics, clinical presentation, surgical interventions, and radiological outcomes were assessed. Results: The study included 24 patients (62.5% male; mean age 65.6 ± 35.0 years), with 58% having healthcare-associated infections (HAVO). The mean radiological follow-up was 137.2 ± 161.7 weeks. Surgical intervention significantly improved the bi-segmental kyphotic endplate angle (BKA) postoperatively (mean −1.4° ± 13.6°). However, a noticeable loss of correction was observed over time. The study reported a mortality rate of 1/24. Conclusions: Anterior column reconstruction using expandable VBR effectively improved local spinal alignment in destructive VO. However, the study underscores the necessity for prolonged follow-up and continuous research to refine surgical techniques and postoperative care. Addressing long-term complications and refining surgical approaches will be pivotal as the field progresses. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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14 pages, 2039 KiB

Open AccessFeature PaperArticle

Diagnostics, Management, and Outcomes in Patients with Pyogenic Spinal Intra- or Epidural Abscess

by Mido Max Hijazi, Timo Siepmann, Ibrahim El-Battrawy, Assem Aweimer, Kay Engellandt, Dino Podlesek, Gabriele Schackert, Tareq A. Juratli, Ilker Y. Eyüpoglu and Andreas Filis

J. Clin. Med. 2023, 12(24), 7691; https://doi.org/10.3390/jcm12247691 - 14 Dec 2023

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Abstract

Background: Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of both entities. Methods: Over a period of 20 years, we retrospectively analyzed the electronic medical records of 78 patients with SIA and SEA. Results: The patients with SIA showed worse motor scores (MS scores) on admission (SIA: 20 ± 26 vs. SEA: 75 ± 34, p < 0.001), more often with an ataxic gait (SIA: 100% vs. SEA: 31.8%, p < 0.001), and more frequent bladder or bowel dysfunction (SIA: 91.7% vs. SEA: 27.3%, p < 0.001) compared to the SEA patients. Intraoperative specimens showed a higher diagnostic sensitivity in the SEA patients than the SIA patients (SIA: 66.7% vs. SEA: 95.2%, p = 0.024), but various pathogens such as Staphylococcus aureus (SIA 33.3% vs. SEA: 69.4%) and Streptococci and Enterococci (SIA 33.3% vs. SEA: 8.1%, p = 0.038) were detected in both entities. The patients with SIA developed sepsis more often (SIA: 75.0% vs. SEA: 18.2%, p < 0.001), septic embolism (SIA: 33.3% vs. SEA: 8.3%, p = 0.043), signs of meningism (SIA: 100% vs. 18.5%, p < 0.001), ventriculitis or cerebral abscesses (SIA: 41.7% vs. SEA: 3.0%, p < 0.001), and pneumonia (SIA: 58.3% vs. SEA: 13.6%, p = 0.002). The mean MS score improved in both patient groups after surgery (SIA: 20 to 35 vs. SEA: 75 to 90); however, the SIA patients showed a poorer MS score at discharge (SIA: 35 ± 44 vs. SEA: 90 ± 20, p < 0.001). C-reactive protein (CrP) (SIA: 159 to 49 vs. SEA: 189 to 27) and leukocyte count (SIA: 15 to 9 vs. SEA: 14 to 7) were reduced at discharge. The SIA patients had higher rates of disease-related mortality (SIA: 33.3% vs. SEA: 1.5%, p = 0.002), had more pleural empyema (SIA: 58.3% vs. SEA: 13.6%, p = 0.002), required more than one surgery (SIA: 33.3% vs. SEA 13.6%, p = 0.009), were treated longer with intravenous antibiotics (7 ± 4 w vs. 3 ± 2 w, p < 0.001) and antibiotics overall (12 ± 10 w vs. 7 ± 3 w, p = 0.022), and spent more time in the hospital (SIA: 58 ± 36 vs. SEA: 26 ± 20, p < 0.001) and in the intensive care unit (SIA: 14 ± 18 vs. SEA: 4 ± 8, p = 0.002). Conclusions: Our study highlighted distinct clinical phenotypes and outcomes between both entities, with SIA patients displaying a markedly less favorable disease course in terms of complications and outcomes. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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13 pages, 714 KiB

Open AccessArticle

In-Hospital Mortality from Spondylodiscitis: Insights from a Single-Center Retrospective Study

by Ann-Kathrin Joerger, Carolin Albrecht, Nicole Lange, Bernhard Meyer and Maria Wostrack

J. Clin. Med. 2023, 12(23), 7228; https://doi.org/10.3390/jcm12237228 - 22 Nov 2023

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Abstract

(1) Background: There is a marked proportion of spondylodiscitis patients who die during the early stage of the disease despite the applied therapy. This study investigates this early mortality and explores the associated risk factors. (2) Methods: We conducted a retrospective analysis of spondylodiscitis patients treated at our Level I spine center between 1 January 2018 and 31 December 2022. (3) Results: Among 430 patients, 32 (7.4%) died during their hospital stay, with a median time of 28.5 days (range: 2.0–84.0 days). Six of these patients (18.75%) did not undergo surgery due to dire clinical conditions or death prior to scheduled surgery. Identified causes of in-hospital death included multiorgan failure (n = 15), acute bone marrow failure (2), cardiac failure (4), liver failure (2), acute respiratory failure (2), acute renal failure (1), and concomitant oncological disease (1). In a simple logistic regression analysis, advanced age (p = 0.0006), diabetes mellitus (p = 0.0002), previous steroid medication (p = 0.0279), Charlson Comorbidity Index (p < 0.0001), and GFR level at admission (p = 0.0008) were significant risk factors for in-hospital death. In a multiple logistic regression analysis, advanced age (p = 0.0038), diabetes mellitus (p = 0.0002), and previous steroid medication (p = 0.0281) remained significant. (4) Conclusions: Despite immediate treatment, a subset of spondylodiscitis patients experience early mortality. Particular attention should be given to elderly patients and those with diabetes or a history of steroid medication, as they face an elevated risk of a rapidly progressing and fatal disease. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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17 pages, 1396 KiB

Open AccessArticle

The Efficacy of Daily Local Antibiotic Lavage via an Epidural Suction–Irrigation Drainage Technique in Spondylodiscitis and Isolated Spinal Epidural Empyema: A 20-Year Experience of a Single Spine Center

by Mido Max Hijazi, Timo Siepmann, Ibrahim El-Battrawy, Percy Schröttner, Dino Podlesek, Kay Engellandt, Gabriele Schackert, Tareq A. Juratli, Ilker Y. Eyüpoglu and Andreas Filis

J. Clin. Med. 2023, 12(15), 5078; https://doi.org/10.3390/jcm12155078 - 2 Aug 2023

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Abstract

Background: Various treatment modalities are available for local antibiotic therapy in spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE), but there is no evidence-based recommendation. Postoperative epidural suction–irrigation drainage (ESID) is thought to reduce bacterial load, which may prevent the development of relapse, wound healing, hematogenous spread, and systemic complications. We evaluated the efficacy of postoperative ESID over 20 years on disease progression and outcome in SD and ISEE. Methods: Detailed demographic, clinical, imaging, laboratory, and microbiological characteristics were examined in our cohorts of 208 SD and ISEE patients treated with and without ESID at a university spine center in Germany between 2002 and 2022. Between-group comparisons were performed to identify meaningful differences for the procedure. Results: We included data from 208 patients (142 SD, 68.3% vs. 66 ISEE, 31.7%) of whom 146 were ESID patients (87 SD, 59.6% vs. 59 ISEE, 40.4%) and 62 were NON-ESID patients (55 SD, 88.7% vs. 7 ISEE, 11.3%). ESID patients with SD showed more frequent SSI (ESID: 22, 25.3% vs. NON-ESID: 3, 5.5%, p = 0.003), reoperations due to empyema persistence or instability (ESID: 37, 42.5% vs. NON-ESID: 12, 21.8%, p = 0.012), and a higher relapse rate (ESID: 21, 37.5% vs. NON-ESID: 6, 16.7%, p = 0.037) than NON-ESID patients with SD. The success rate in NON-ESID patients with SD was higher than in ESID patients with SD (ESID: 26, 29.9% vs. NON-ESID: 36, 65.6%, p < 0.001). Multivariate binary logistic regression analysis showed that ESID therapy (p < 0.001; OR: 0.201; 95% CI: 0.089–0.451) was a significant independent risk factor for treatment failure in patients with SD. Conclusions: Our retrospective cohort study with more than 20 years of experience in ESID technique shows a negative effect in patients with SD in terms of surgical site infections and relapse rate. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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10 pages, 2319 KiB

Open AccessArticle

Risk Factors for the In-Hospital Mortality in Pyogenic Vertebral Osteomyelitis: A Cross-Sectional Study on 9753 Patients

by Tomasz Piotr Ziarko, Nike Walter, Melanie Schindler, Volker Alt, Markus Rupp and Siegmund Lang

J. Clin. Med. 2023, 12(14), 4805; https://doi.org/10.3390/jcm12144805 - 21 Jul 2023

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Abstract

Background: Pyogenic vertebral osteomyelitis represents a clinical challenge associated with significant morbidity and mortality. The aim of this study was to analyze potential risk factors for the in-hospital mortality of vertebral osteomyelitis (VO) patients. Methods: Based on the International Classification of Diseases, 10th Revision (ICD-10) codes for VO (“M46.2-”, “M46.3-”, and “M46.4-”) data for total case numbers, secondary diagnoses, and numbers of in-hospital deaths were extracted from the Institute for the Hospital Remuneration System (InEK GmbH). Odds ratios (OR) for death were calculated for several secondary diseases and factors of interest. Results: Despite age, certain comorbidities were found to be strongly associated with increased mortality risk: Heart failure (OR = 2.80; 95% CI 2.45 to 3.20; p < 0.01), chronic kidney disease (OR = 1.83; 95% CI 1.57 to 2.13; p < 0.01), and diabetes with complications (OR = 1.86; 95% CI 1.46 to 2.38; p < 0.01). Among the complications, acute liver failure showed the highest risk for in-hospital mortality (OR = 42.41; 95% CI 23.47 to 76.62; p < 0.01). Additionally, stage III kidney failure (OR = 9.81; 95% CI 7.96 to 12.08; p < 0.01), sepsis (OR = 5.94; 95% CI 5.02 to 7.03; p < 0.01), acute respiratory failure (OR = 5.31; 95% CI 4.61 to 6.12; p < 0.01), and systemic inflammatory response syndrome (SIRS) (OR = 5.19; 95% CI 3.69 to 5.19; p < 0.01) were associated with in-hospital mortality. When analyzing the influence of pathogens, documented infection with Pseudomonas aeruginosa had the highest risk for mortality (OR = 2.74; 95% CI 2.07 to 3.63; p < 0.01), followed by Streptococci, Escherichia coli, and Staphylococcus aureus infections. Conclusions: An early assessment of individual patient risk factors may be beneficial in the care and treatment of VO to help reduce the risks of mortality. These findings emphasize the importance of closely monitoring VO patients with chronic organ diseases, early detection and treatment of sepsis, and tailored empirical antibiotic therapy. The identification of specific pathogens and antibiotic susceptibility testing should be prioritized to improve patient outcomes in this high-risk population. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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20 pages, 1687 KiB

Open AccessArticle

Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review

by Stamatios A. Papadakis, Margarita-Michaela Ampadiotaki, Dimitrios Pallis, Konstantinos Tsivelekas, Petros Nikolakakos, Labrini Agapitou and George Sapkas

J. Clin. Med. 2023, 12(13), 4509; https://doi.org/10.3390/jcm12134509 - 5 Jul 2023

Cited by 1 | Viewed by 1868

Abstract

Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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15 pages, 2286 KiB

Open AccessArticle

Diagnostic Sensitivity of Blood Culture, Intraoperative Specimen, and Computed Tomography-Guided Biopsy in Patients with Spondylodiscitis and Isolated Spinal Epidural Empyema Requiring Surgical Treatment

by Mido Max Hijazi, Timo Siepmann, Alexander Carl Disch, Uwe Platz, Tareq A. Juratli, Ilker Y. Eyüpoglu and Dino Podlesek

J. Clin. Med. 2023, 12(11), 3693; https://doi.org/10.3390/jcm12113693 - 26 May 2023

Cited by 1 | Viewed by 1120

Abstract

Background: the successful treatment of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) depends on early detection of causative pathogens, which is commonly performed either via blood cultures, intraoperative specimens, and/or image-guided biopsies. We evaluated the diagnostic sensitivity of these three procedures and assessed how it is influenced by antibiotics. Methods: we retrospectively analyzed data from patients with SD and ISEE treated surgically at a neurosurgery university center in Germany between 2002 and 2021. Results: we included 208 patients (68 [23–90] years, 34.6% females, 68% SD). Pathogens were identified in 192 cases (92.3%), including 187 (97.4%) pyogenic and five (2.6%) non-pyogenic infections, with Gram-positive bacteria accounting for 86.6% (162 cases) and Gram-negative for 13.4% (25 cases) of the pyogenic infections. The diagnostic sensitivity was highest for intraoperative specimens at 77.9% (162/208, p = 0.012) and lowest for blood cultures at 57.2% (119/208) and computed tomography (CT)-guided biopsies at 55.7% (39/70). Blood cultures displayed the highest sensitivity in SD patients (SD: 91/142, 64.1% vs. ISEE: 28/66, 42.4%, p = 0.004), while intraoperative specimens were the most sensitive procedure in ISEE (SD: 102/142, 71.8% vs. ISEE: 59/66, 89.4%, p = 0.007). The diagnostic sensitivity was lower in SD patients with ongoing empiric antibiotic therapy (EAT) than in patients treated postoperatively with targeted antibiotic therapy (TAT) (EAT: 77/89, 86.5% vs. TAT: 53/53, 100%, p = 0.004), whereas no effect was observed in patients with ISEE (EAT: 47/51, 92.2% vs. TAT: 15/15, 100%, p = 0.567). Conclusions: in our cohort, intraoperative specimens displayed the highest diagnostic sensitivity especially for ISEE, whereas blood cultures appear to be the most sensitive for SD. The sensitivity of these tests seems modifiable by preoperative EAT in patients with SD, but not in those with ISEE, underscoring the distinct differences between both pathologies. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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10 pages, 1284 KiB

Open AccessEditor’s ChoiceArticle

The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020

by Siegmund Lang, Nike Walter, Melanie Schindler, Susanne Baertl, Dominik Szymski, Markus Loibl, Volker Alt and Markus Rupp

J. Clin. Med. 2023, 12(10), 3373; https://doi.org/10.3390/jcm12103373 - 9 May 2023

Cited by 9 | Viewed by 1580

Abstract

Background: Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. Methods: This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as the pathogens, in-hospital mortality rate, and length of hospital stay. Data were obtained from the Federal Statistical Office and the Institute for the Hospital Remuneration System database. The ICD-10 codes “M46.2-”, “M46.3-” and “M46.4-” were evaluated. Results: The incidence rate of spondylodiscitis increased to 14.4/100,000 inhabitants, with 59.6% cases occurring in patients 70 years or older and affecting mainly the lumbar spine (56.2%). Absolute case numbers increased from 6886 by 41.6% to 9753 in 2020 (IIR = 1.39, 95% CI 0.62–3.08). Staphylococci and Escherichia coli were the most coded pathogens. The proportion of resistant pathogens was 12.9%. In-hospital mortality rates increased to a maximum of 64.7/1000 patients in 2020, intensive care unit treatment was documented in 2697 (27.7%) cases, and the length of stay per case was 22.3 days. Conclusion: The sharply increasing incidence and in-hospital mortality rate of spondylodiscitis highlights the need for patient-centered therapy to improve patient outcomes, especially in the geriatric, frail population, which is prone to infectious diseases. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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Review

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18 pages, 1222 KiB

Open AccessReview

Brucella Spondylitis: Current Knowledge and Recent Advances

by Nikolaos Spernovasilis, Apostolos Karantanas, Ioulia Markaki, Afroditi Konsoula, Zisis Ntontis, Christos Koutserimpas and Kalliopi Alpantaki

J. Clin. Med. 2024, 13(2), 595; https://doi.org/10.3390/jcm13020595 - 19 Jan 2024

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Abstract

The most prevalent zoonotic disease is brucellosis, which poses a significant threat for worldwide public health. Particularly in endemic areas, spinal involvement is a major source of morbidity and mortality and can complicate the course of the disease. The diagnosis of Brucella spondylitis is challenging and should be suspected in the appropriate epidemiological and clinical context, in correlation with microbiological and radiological findings. Treatment depends largely on the affected parts of the body. Available treatment options include antibiotic administration for an adequate period of time and, when appropriate, surgical intervention. In this article, we examined the most recent data on the pathophysiology, clinical manifestation, diagnosis, and management of spinal brucellosis in adults. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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28 pages, 5105 KiB

Open AccessReview

Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic Literature Review

by Redwan Jabbar, Bartosz Szmyd, Jakub Jankowski, Weronika Lusa, Agnieszka Pawełczyk, Grzegorz Wysiadecki, R. Shane Tubbs, Joe Iwanaga and Maciej Radek

J. Clin. Med. 2022, 11(17), 5148; https://doi.org/10.3390/jcm11175148 - 31 Aug 2022

Cited by 5 | Viewed by 2094

Abstract

Intramedullary spinal cord abscess (ISCA) is a rare clinical pathology of the central nervous system that usually accompanies other underlying comorbidities. Traditionally it has been associated with significant mortality and neurological morbidities because it is often difficult to diagnose promptly, owing to its nonspecific clinical and neuroimaging features. The mortality rate and the outcome of these infections have been improved by the introduction into clinical practice of antibiotics, advanced neuroimaging modalities, and immediate surgery. We report the case of a 65-year-old male patient who presented with a progressive spastic gait and lumbar pain, predominantly in the left leg. An MRI image revealed an expansile intramedullary cystic mass in the thoracic spinal cord, which was initially diagnosed as a spinal tumor. He underwent laminectomy and myelotomy, and eventually the pus was drained from the abscess. The follow-up MRI showed improvement, but the patient’s paraplegia persisted. In light of his persistent hypoesthesia and paraplegic gait with developing neuropathic pain, he was readmitted, and an MRI of his lumbar spine revealed multilevel degenerative disease and tethered spinal cord syndrome with compression of the medulla at the L2–L3 level. The patient underwent central flavectomy with bilateral foraminotomy at the L2–L3 level, and the medulla was decompressed. Postoperatively, his neurological symptoms were significantly improved, and he was discharged from hospital on the third day after admission. In support of our case, we systematically reviewed the recent literature and analyzed cases published between 1949 and May 2022, including clinical features, mechanisms of infection, predisposing factors, radiological investigations, microbial etiologies, therapies and their duration, follow-ups, and outcomes. Initial clinical presentation can be misleading, and the diagnosis can be challenging, because this condition is rare and coexists with other spinal diseases. Hence, a high index of suspicion for making an accurate diagnosis and timely intervention is required to preclude mortality and unfavorable outcomes. Our case is a clear example thereof. Long-term follow-up is also essential to monitor for abscess recurrences. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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