Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part A Pyogenic Spondylodiscitis

Abstract

Study Design Systematic review with guidelines. Objective To develop evidence-based, globally applicable recommendations for diagnosis and management of pyogenic spondylodiscitis (PSI) as a part of the International Consensus Meeting (ICM) 2025 on Spinal Infection. Methods A multi-phase consensus process combined systematic evidence appraisal (PubMed, Scopus, Web of Science, Clinicaltrials.org) with structured expert deliberation. Seven domains were explored: diagnosis, microbiological workup, antibiotic management, response assessment, morphology-based planning, surgical techniques, and adjunctive measures. Results Expert consensus established that serum albumin (<3.5 g/dL) is a critical prognostic marker, while ESR and CRP remain the most reliable diagnostic tests. The assembly strongly rejected initiating empirical treatment without tissue diagnosis, even in early-stage infection. Surgical fixation is recommended for instability, deformity, or neurological deficit, with instrumentation levels tailored to bone destruction and patient-specific factors like osteoporosis. While MRI is the gold standard for initial diagnosis, its role in monitoring is limited, as radiological progression in clinically stable patients does not necessitate surgery. Advanced adjuncts, including Next-Generation Sequencing (NGS) and Vacuum-Assisted Closure (VAC), show promise in enhancing pathogen detection and wound healing, respectively. Conclusion Effective PSI management requires integrating clinical, laboratory, and morphological data. Meticulous debridement and targeted antimicrobial therapy remain the cornerstones of treatment. This consensus provides a practical guide for clinicians while highlighting the need for prospective, multicenter research to validate emerging technologies and standardize global surgical protocols.