Diagnosis and Treatment of Nonspecific Spondylodiscitis in Adults in Germany, Austria, and Switzerland (DACH): Analysis of an Online Survey

Abstract

Background

Approaches to the diagnosis and treatment of pyogenic spondylodiscitis vary significantly across German-speaking countries. To assess current clinical practice and compare it with prior data, a survey was conducted following the publication of the 2020 S2k guideline on the diagnosis and treatment of spondylodiscitis.

Methods

A standardized and anonymized 32-item online questionnaire was distributed to members of the German Spine Society (DWG) between April and September 2021. The survey evaluated diagnostic workflows, therapeutic strategies, and guideline adherence in Germany, Austria, and Switzerland (DACH region). Findings were compared with data from a similar survey conducted in 2014.

Results

A total of 220 respondents completed the survey; 36% worked in certified spine centres. Decisions regarding diagnosis and treatment were most frequently made during internal team meetings (60.3%) or by senior physicians (59.3%). Interdisciplinary case conferences were held in 30.8% of hospitals. Two-thirds of respondents reported the use of standardized operating procedures (SOPs), and 75.2% had integrated the current guideline into clinical routines.
Diagnostic procedures were largely standardized: 98% performed focused history taking and source identification. Common investigations included echocardiography, urinalysis, chest X-ray, and whole-spine MRI—all used by over 80% of respondents. In more than 85% of cases, diagnosis was based on imaging, CRP levels, and clinical symptoms, followed by microbiological confirmation.
In conservative treatment settings, targeted antibiotic therapy was initiated after pathogen identification in 74% of cases; in surgically managed cases, this occurred in 36%. Sepsis and fever were the most common reasons for empirical (non-targeted) therapy. The most frequently used empirical agents were clindamycin (41.6%) and ampicillin/sulbactam (28.3%).

Initial treatment was administered intravenously for at least two weeks in 85.2% of cases, followed by oral therapy for a total duration of 6–12 weeks in 83%. Therapy duration ≤ 6 weeks was reported by 10.1%. Biofilm-active antibiotics were used in 49.3% of cases—especially when foreign material was present (59.8%) or newly implanted (50.2%).
Emergency surgery was most often triggered by neurological deficits and epidural abscesses. Titanium was the most frequently used material for defect reconstruction (81%). Locally applied antibiotics included gentamicin (66.2%) and vancomycin (57.9%). Orthotic bracing was prescribed by 67.7% of respondents during conservative treatment.
Notable differences between certified and non-certified institutions were found in the selection of empirical antibiotics and the use of locally applied agents.

Conclusion

Since the last survey in 2014, clinical management of spondylodiscitis in the DACH region has shown increased standardization, particularly in diagnostic procedures and guideline implementation. However, variability remains in empirical antibiotic selection and the use of local antimicrobial therapy, underlining the need for further harmonization of treatment strategies.

Keywords

spondylodiscitis - online survey - guideline - diagnostics - therapy

Publication History

Received: 09 April 2025

Accepted after revision: 03 December 2025

Article published online:
17 February 2026

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