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

Abstract

Study Design Systematic review with guidelines. Objective To develop evidence-based, globally applicable recommendations for diagnosis and management of Tubercular spondylodiscitis (TBSD) as a part of the International Consensus Meeting (ICM) 2025 on Spinal Infection. Methods This article represents a structured, multi-phase international consensus process conducted under the auspices of ICM 2025. Systematic literature reviews were performed using PubMed, Scopus, Web of Science, and ClinicalTrials.gov in accordance with Cochrane methodology. Evidence synthesis was integrated with structured expert deliberation. Consensus statements were developed across 7 domains: screening and initial evaluation, imaging, microbiological diagnosis, anti-tubercular therapy, response monitoring and conservative management, surgical indications, and surgical techniques. Recommendations were finalised through structured voting, with levels of evidence assigned to each statement. Results The consensus emphasises early recognition, routine HIV screening, lesion-specific tissue diagnosis with drug-susceptibility testing, and a multimodal diagnostic strategy. MRI remains the primary imaging modality but lacks specificity for etiological differentiation. Six months of rifampicin-based chemotherapy is sufficient in clinically responding patients, irrespective of surgery. Surgery is indicated for neurological deficit associated with instability or deformity, progressive deterioration, or failure of conservative management. Posterior-only approaches are appropriate in most thoracic and lumbar cases, with anterior surgery reserved for selected indications. Conclusion The ICM 2025 recommendations provide a comprehensive, evidence-informed framework for the diagnosis and management of TBSD and aim to standardise care while guiding future research priorities worldwide.