Overview and classification of spinal infections.

Hematogenous spread is the most common cause for vertebral osteomyelitis. S. aureus is the most common organism in pyogenic vertebral osteomyelitis. Hematogenous osteomyelitis is common among diabetics and intravenous drug abusers. Tuberculous spondylitis remains common worldwide. In general, vertebral body infections not responding to antibiotic treatment and those creating unacceptable deformity or neurologic compromise require debridement via an anterior approach with strut grafting. Posterior infections are almost always postsurgical and require posterior irrigation and debridement in addition to antibiotics. Abscesses within the canal require antibiotics and surgical debridement especially when neurologic symptoms are present. Infections within the canal are approached posteriorly unless the pathology involves the anterior spine. Use of metal fixation within the site of an adequately debrided spinal infection is controversial but necessary on rare occasions. Posterior fixation for anterior infections is preferred. Much has been written about spinal infections and their treatment. Landmark articles and additional comprehensive sources on spinal infections have been included in the references.