• Inflammation of intervertebral disk tissue and adjacent vertebrae, which are normally resistant to infection due to avascularity
• Usually associated with back pain (since involves lumbar segments), ages 50+ years, male predominance
• Spondylodiskitis commonly involves lumbar (45%), thoracic (35%), and cervical (10-20%) spine; causes secondary epidural abscess most commonly in cervical spine, also thoracic and lumbar spine
• Increased frequency of diagnosis due to magnetic resonance imaging
• Most cases are due to pyogenic organisms (Staph, Strep); also Candida, Aspergillus, Cryptococcus, Mycobacterium tuberculosis; rarely Enterococcus

• Culture usually positive (78%), special stains are usually negative

Destruction of vertebral bodies and disk tissue

• 14 year old girl with fungal thoracic spondylodiskitis (J Nippon Med Sch 2009;76:265)
• 35 year old man with tuberculous spondylodiskitis with lumbar tumor (Reumatol Clin 2012;8:292)
• 42 year old man with chronic hemodialysis and Aspergillus fumigatus spondylodiskitis (Exp Clin Transplant 2011;9:265)
• 62 year old man with sigmoid carcinoma and Candida tropicalis spondylodiskitis (Cases J 2008 Jul 29;1:66)
• 70 year old man with recurrent infective endocarditis associated with pyogenic spondylodiskitis (Korean Circ J 2011;41:167)

Intervertebral disc (top center) destroyed by vertebral abscess

Spinal cord compressed by abscess

• Vascularization, myxoid degeneration, necrosis of disk, chronic osteomyelitis
• Variable acute osteomyelitis (25%), granulation tissue
• Tuberculous infection has caseating granulomas

Primary Aspergillus spondylodiscitis in liver transplant recipient

G/H: inflammatory cells and bacteria

C. tropicalis

• Arch Pathol Lab Med 2000;124:712, eMedicine

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