Primary pyogenic spinal infection, also known as spondylodiscitis or vertebral osteomyelitis, is a serious and potentially debilitating condition involving a bacterial or fungal infection of the intervertebral disc space and adjacent vertebral bodies. While relatively uncommon, with an estimated incidence of 2.4 per 100,000 population per year, it is a medical emergency that requires prompt diagnosis and treatment to prevent permanent spinal damage and neurological complications. The most common causative organisms are Staphylococcus aureus, which accounts for up to 50% of cases, followed by Gram-negative bacteria such as Escherichia coli, and mycobacterial infections like Mycobacterium tuberculosis. Risk factors for developing primary pyogenic spinal infection include intravenous drug use, a weakened immune system, recent spinal surgery or instrumentation, and contiguous spread from an infection elsewhere in the body, such as a urinary tract infection or endocarditis. Patients typically present with severe, localized back pain, fever, and general malaise, which can easily be mistaken for more common spinal conditions. Prompt diagnosis is critical and involves a thorough medical history, physical examination, laboratory testing, and advanced imaging studies such as magnetic resonance imaging (MRI). Blood cultures and, in some cases, image-guided biopsy may be necessary to identify the causative organism and guide appropriate antimicrobial therapy. The mainstay of treatment is the prompt initiation of targeted antibiotic or antifungal therapy, often requiring intravenous administration for several weeks. Surgical intervention may be necessary in some cases, such as to drain an abscess or provide spinal stabilization. A multidisciplinary approach involving infectious disease specialists, spine surgeons, and rehabilitation providers is essential for optimal management and outcomes. Despite advances in diagnosis and treatment, primary pyogenic spinal infection remains a challenging condition. Delays in diagnosis and treatment can lead to devastating complications, including permanent spinal deformity, paralysis, and even death. With timely and appropriate management, however, most patients are able to achieve a good clinical outcome, though some may experience residual pain or neurological deficits.
