Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 31:5:104178.
doi: 10.1016/j.bas.2024.104178. eCollection 2025.

Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations

Andreas Kramer  1 , Santhosh G Thavarajasingam  1 , Jonathan Neuhoff  2 , Benjamin Davies  3 , Giuseppe Barbagallo  4 , Bertrand Debono  5 , Bart Depreitere  6 , Sven O Eicker  7 , Nikolay Gabrovsky  8 , Marisa L Gandia-Gonzalez  9 , Marcel Ivanov  10 , Radek Kaiser  11 , Stanislav Kaprovoy  12 , Nikolay Konovalov  12 , Jesus Lafuente  13 , Andrzej Maciejczak  14   15 , Bernhard Meyer  16 , Paulo Pereira  17   18 , Yana Petrova  19 , Wilco C Peul  20 , Carla Reizinho  21 , Yu-Mi Ryang  16   22 , Nico Sampron  23 , Ralph Schär  24 , Enrico Tessitore  25 , Claudius Thomé  26 , Jake Timothy  27 , Carmen Vleggeert-Lankamp  28 , Andreas K Demetriades  29 , Ehab Shiban  30 , Florian Ringel  1
Affiliations

Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations

Andreas Kramer et al. Brain Spine. .

Abstract

Introduction: The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery.

Research question: This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies.

Material and methods: A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts.

Results: Consensus was reached on 38 of 62 statements. MRI was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. Motor deficits with a motor score (MRC) below 4 and bladder or bowel dysfunction were unanimously considered clear indications for surgery. For spinal deformity and instability, thresholds such as kyphosis >20°, scoliosis >10°, and vertebral body collapse >50% were established to guide surgical decision-making. Minimally invasive surgery (MIS) was endorsed whenever feasible, and a 12 week antibiotic treatment regimen was favored in cases of complicated infections.

Discussion and conclusion: This EANS consensus provides updated recommendations for SD management, incorporating recent evidence on improved outcomes with surgical therapy. While these guidelines offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies.

Keywords: Consensus; De novo spinal infection; Discitis; Non-specific; Pyogenic; Spinal osteomyelitis; Spondylodiscitis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Arterial dissemination of spinal infections (A) and venous dissemination via Batson plexus (B).
Fig. 2
Fig. 2
Synopsis of the Delphi process.
Fig. 3
Fig. 3
Delphi process responses of round 2 (A) and 3 (B).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Appalanaidu N., Shafafy R., Gee C., et al. Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS) Eur. Spine J. 2019;28(4):751–761. - PubMed
    1. Arbelaez A., Restrepo F., Castillo M. Spinal infections: clinical and imaging features. Top. Magn. Reson. Imag. 2014;23(5):303–314. - PubMed
    1. Berbari E.F., Kanj S.S., Kowalski T.J., et al. Infectious diseases society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin. Infect. Dis. 2015;61(6):e26–e46. 2015. - PubMed
    1. Bernard L., Dinh A., Ghout I., et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet. 2015;385(9971):875–882. - PubMed
    1. Dunbar J.A., Sandoe J.A., Rao A.S., Crimmins D.W., Baig W., Rankine J.J. The MRI appearances of early vertebral osteomyelitis and discitis. Clin. Radiol. 2010;65(12):974–981. - PubMed