CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(04): 724-733
DOI: 10.1055/s-0043-1777272
Review Article

A Comprehensive Review of Pyogenic Spondylitis Management for Neurosurgeons

Masatoshi Yunoki
1   Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagaw, Japan
› Author Affiliations


Older populations have been increasing recently, resulting in an increase in cases of pyogenic spondylitis. Neurosurgeons who frequently treat the elderly are at a higher risk of encountering this condition. Therefore, this article provides a summary of the literature and our experience to help neurosurgeons effectively manage pyogenic osteomyelitis. It is important not to rule out pyogenic spondylosis when examining a patient with back pain, even in the absence of a fever. This is because the chronic type is common, easily overlooked, and early diagnosis and treatment are crucial. Empirical antibiotics should be avoided in cases where blood culture and biopsy are negative, to prevent microbial resistance and an increase in difficult-to-treat cases. Biopsies, such as computed tomography-guided percutaneous biopsy and full endoscopic debridement and drainage, should be attempted. Currently, 6 weeks of parenteral antibiotic therapy is the main treatment for pyogenic spondylitis. Surgical treatment is recommended if this method is ineffective. However, in the early stages, full endoscopic debridement and drainage and percutaneous pedicle screw fixation are optional.

Publication History

Article published online:
29 December 2023

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