The spondylodiscitis can be classified according to cause, course, and localization:

1. **According to cause:**

- **Bacterial:** Most common form, usually caused by Staphylococcus aureus.

- **Mycotic:** Rarer, due to fungal infections like Candida or Aspergillus.

- **Non-infectious:** Inflammations due to autoimmune diseases or degenerative processes.

2. **According to course:**

- **Acute:** Sudden onset with severe pain and systemic symptoms.

- **Chronic:** Slow progression with diffuse complaints and insidious disease pattern.

3. **According to localization:**

- **Cervical spondylodiscitis:** Involvement of the cervical spine.

- **Thoracic spondylodiscitis:** Rarer form affecting the thoracic spine.

- **Lumbar spondylodiscitis:** Most common form, as the lumbar spine is most heavily burdened.

The main causes of spondylodiscitis can be divided into infectious and non-infectious factors:

• Infectious causes:
  • Hematogenous spread: Pathogens reach the intervertebral discs via the bloodstream, e.g., in cases of endocarditis, skin infections, or urinary tract infections.
  • Direct inoculation: Infiltration of germs during spinal surgeries, injections, or trauma.
  • Local spread: Infections from adjacent structures such as abscesses can spread to the spine.
• Non-infectious causes:
  • Rheumatic diseases such as ankylosing spondylitis or systemic lupus erythematosus.
  • Traumatic injuries to the spine with secondary inflammations.

The symptoms vary depending on the cause, course, and severity of the disease, but typically include:

• Local pain: Severe, persistent back pain that occurs equally at rest and during movement.
• Fever: Often accompanied by chills, as a sign of a systemic infection.
• Movement restrictions: Pain and stiffness in the affected section of the spine.
• Fatigue and weakness: General symptoms in chronic infections.
• Neurological symptoms: As the disease progresses, numbness, paralysis, or other neurological deficits may occur if the spinal cord or nerve roots are compressed.

The diagnosis requires a thorough medical history, clinical examination, and a combination of imaging and laboratory diagnostic procedures:

- Medical history:

- Inquiry about previous infections, surgeries, or injuries.

- Clinical examination:

- Local tenderness in the spine and tests to check neurological functions.

- Imaging procedures:

- MRI: Gold standard for depicting inflammation, tissue changes, and abscesses.

- CT: Complementary for assessing bony destructions.

- X-ray: Late stages show vertebral body destructions and disc damage.

- Laboratory tests:

- Inflammatory markers such as CRP and ESR are elevated.

- Blood cultures to detect the pathogen.

- Tissue biopsy for microbiological and histological analysis.

Conservative Therapy

In most cases, spondylodiscitis can be successfully treated conservatively:

• Antibiotic Therapy:
  • Broad-spectrum antibiotics, adjusted to the identified pathogen.
  • Long-term intravenous and oral antibiotic therapy over several weeks.
• Pain Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Stronger analgesics for severe pain.
• Immobilization:
  • Stabilization of the spine with a corset or orthoses to minimize stress.
• Physiotherapy:
  • After the acute phase subsides, to restore mobility and strengthen the back muscles.

Surgical Therapy

Surgery becomes necessary if conservative measures are insufficient or complications arise:

• Decompression and Drainage:
  • Removal of abscesses or necrotic tissue to relieve pressure.
• Spinal Stabilization:
  • Use of implants or plates to fuse unstable segments.
• Reconstruction:
  • Restoration of spinal structure in cases of severe bone damage.

The following measures are suitable for preventing spondylodiscitis and minimizing the risk:

1. Early treatment of infections: Consistent therapy of bacterial infections to prevent spreading.
2. Hygiene during procedures: Strict sterile conditions during surgeries and injections.
3. Strengthening the immune system: Healthy diet, exercise, and avoidance of risk factors such as smoking.
4. Regular check-ups: Especially for at-risk patients or after spinal procedures.
5. Risk management: Preventive measures for patients with known immune deficiencies or other underlying conditions.