Cervical Pyogenic Spondylitis: A Comprehensive Review of Diagnosis and Treatment Strategy

Abstract

Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine's narrow canal and proximity to critical neurovascular structures. Early diagnosis relies on a high index of suspicion supported by MRI, inflammatory markers, blood cultures, and tissue biopsy. Empirical intravenous antibiotics remain the cornerstone of initial treatment, followed by pathogen-specific therapy. Surgical intervention is indicated in cases of neurological deterioration, spinal instability, or failure of conservative management. Anterior approaches, including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), are widely used, with anterior plating providing biomechanical advantages in select cases. Posterior or combined anterior-posterior approaches are recommended in multilevel disease, deformity, or posterior element involvement. Graft selection-typically autograft or titanium/PEEK cages-must consider infection severity and biomechanical demands. Challenges in CPS management include optimal debridement extent, graft choice in infected environments, the standardization of antibiotic protocols, and the prevention of recurrence. This narrative review synthesizes the cervical-spine-specific literature on diagnosis, treatment strategies, surgical techniques, and postoperative care and proposes the following practical clinical guidance: (1) early MRI for timely diagnosis, (2) prompt surgical intervention in patients with neurological deficits or mechanical instability, and (3) individualized graft selection based on infection severity and bone quality.

Keywords: antibiotic therapy; cervical spine; diagnosis; interbody graft; pyogenic spondylitis; spinal instrumentation; surgical intervention.

Figure 1

Plain radiograph (A) and magnetic resonance imaging (B,C) demonstrate destructive changes in the C3–C4 vertebral bodies with kyphotic deformity accompanied by retropharyngeal and epidural abscesses compressing the spinal cord.

Figure 2

Diagnostic algorithm for CPS.

Figure 3

Initial plain radiograph (A) and magnetic resonance imaging (B) demonstrate disc space narrowing at C4–C5 with retropharyngeal and epidural abscesses. The patient underwent C4–C5 discectomy with autograft, anterior plating, and posterior wiring (C), achieving solid fusion and complete resolution of spondylodiscitis at one year postoperatively.

Figure 4

Initial magnetic resonance imaging (A) demonstrates disc space narrowing at C5–C6 and destructive changes in the C6 vertebral body with retropharyngeal and epidural abscesses. The patient underwent C5–C7 corpectomy with autograft and anterior plating (B), achieving solid fusion and complete resolution of spondylodiscitis at six months postoperatively.

Figure 5

Initial magnetic resonance imaging (A) demonstrates disc space narrowing at C4–C5 and a large epidural abscess causing spinal cord compression. The patient underwent C4–C6 corpectomy with autograft and anterior plating (B), achieving solid fusion and complete resolution of spondylodiscitis at six months postoperatively (C).

Figure 6

Initial plain radiograph (A) and magnetic resonance imaging (MRI) (B) demonstrate disc space narrowing at C4–C5 with a retropharyngeal abscess. After one month of antibiotic treatment, follow-up plain radiograph (C) and MRI (D) reveal progressive destructive changes in the C4–C5 vertebral bodies with kyphotic deformity, accompanied by retropharyngeal and epidural abscesses compressing the spinal cord. The patient underwent C3–C5 corpectomy with autograft and anterior plating (E), achieving solid fusion and complete resolution of spondylodiscitis at one year postoperatively (F).

Figure 7

Initial magnetic resonance imaging (A) and plain radiograph (B) demonstrate disc space narrowing at C6–C7 with a retropharyngeal abscess. The patient underwent C6–C7 discectomy with autograft without anterior plating (C); however, collapse of the autograft and development of kyphosis were observed at two months postoperatively (D).