{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:06:57Z","timestamp":1793293617096,"version":"4.5.0"},"reference-count":70,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T00:00:00Z","timestamp":1747440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine\u2019s 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\u2013posterior approaches are recommended in multilevel disease, deformity, or posterior element involvement. Graft selection\u2014typically autograft or titanium\/PEEK cages\u2014must 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.<\/jats:p>","DOI":"10.3390\/jcm14103519","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T06:31:29Z","timestamp":1747636289000},"page":"3519","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cervical Pyogenic Spondylitis: A Comprehensive Review of Diagnosis and Treatment Strategy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4237-4556","authenticated-orcid":false,"given":"Chae-Gwan","family":"Kong","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Uijeongbu St. Mary\u2019s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu 11765, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0062-9373","authenticated-orcid":false,"given":"Sung-Kyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chonnam National University Medical College & Hospital, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8273-3731","authenticated-orcid":false,"given":"Jong-Beom","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Uijeongbu St. Mary\u2019s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu 11765, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00024720-200204000-00004","article-title":"Osteomyelitis of the cervical spine: A potentially dramatic disease","volume":"15","author":"Schimmer","year":"2002","journal-title":"J. Spinal. Disord. Tech."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.jcma.2013.07.011","article-title":"Primary cervical osteomyelitis","volume":"76","author":"Tsai","year":"2013","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_3","first-page":"E43","article-title":"Vertebral infection","volume":"14","author":"Jevtic","year":"2004","journal-title":"Eur. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1007\/s00586-013-2995-y","article-title":"Cervical pyogenic spinal infections: Are they more severe diseases than infections in other vertebral locations?","volume":"22","author":"Urrutia","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.semarthrit.2008.03.002","article-title":"Pyogenic vertebral osteomyelitis: A systematic review of clinical characteristics","volume":"39","author":"Mylona","year":"2009","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/bmb\/ldw003","article-title":"Vertebral osteomyelitis in adults: An update","volume":"117","author":"Nickerson","year":"2016","journal-title":"Br. Med. Bull."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1308\/rcsann.2015.0009","article-title":"Management of adult spontaneous spondylodiscitis and its rising incidence","volume":"97","author":"Sur","year":"2015","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00586-018-5598-9","article-title":"Multidisciplinary management of pyogenic spondylodiscitis: Epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients","volume":"27","author":"Pola","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Guo, W., Wang, M., Chen, G., Chen, K.H., Wan, Y., Chen, B., Zou, X., and Peng, X. (2021). Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04155-2"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/CORR.0000000000001866","article-title":"Treatment guideline for patients with native culture-negative pyogenic vertebral osteomyelitis","volume":"480","author":"Lee","year":"2022","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49S","DOI":"10.1177\/2192568218799058","article-title":"Presentation and outcomes after medical and surgical treatment versus medical treatment alone of spontaneous infectious spondylodiscitis: A systematic literature review and meta-analysis","volume":"8","author":"Taylor","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s00586-016-4827-3","article-title":"Management of destructive Candida albicans spondylodiscitis of the cervical spine: A systematic analysis of literature illustrated by an unusual case","volume":"26","author":"Horn","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E57","DOI":"10.1097\/BSD.0b013e318227ed9d","article-title":"Clinical features of cervical pyogenic spondylitis and intraspinal abscess","volume":"24","author":"Miyazaki","year":"2011","journal-title":"J. Spinal. Disord. Tech."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/PL00011954","article-title":"Spinal epidural abscess: A meta-analysis of 915 patients","volume":"23","author":"Reihsaus","year":"2000","journal-title":"Neurosurg. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.wneu.2017.04.119","article-title":"Cervical spondylodiscitis: Presentation, timing, and surgical management in 59 patients","volume":"103","author":"Ghobrial","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sung, M.J., Kim, S.K., and Seo, H.Y. (2022). Chronological analysis of primary cervical spine infection: A single-center analysis of 59 patients over three decades (1992\u20132018). J. Clin. Med., 11.","DOI":"10.3390\/jcm11082210"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/jac\/dkq303","article-title":"Spondylodiscitis: Update on diagnosis and management","volume":"65","author":"Gouliouris","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1302\/0301-620X.101B3.BJJ-2018-0491.R2","article-title":"The role of histology in the diagnosis of spondylodiscitis: Correlation with clinical and microbiological findings","volume":"101","author":"Iwata","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.3174\/ajnr.A5337","article-title":"Yield of image-guided needle biopsy for infectious discitis: A systematic review and meta-analysis","volume":"38","author":"McNamara","year":"2017","journal-title":"Am. J. Neuroradiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/RMR.0000000000000032","article-title":"Spinal infections: Clinical and imaging features","volume":"23","author":"Arbelaez","year":"2014","journal-title":"Top. Magn. Reson. Imaging"},{"key":"ref_21","first-page":"8","article-title":"Imaging of spondylodiscitis","volume":"16","author":"Leone","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/s00259-012-2062-7","article-title":"Prosthetic jount infections: Radionuclide stare-of-the-art imaging","volume":"39","author":"Gemmel","year":"2012","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.spinee.2023.01.019","article-title":"The use of MRI, PET\/CT, and nuclear scintigraphy in the imaging og pyogenic native vertebreal osteomyelitis: A systemic review and meta-analysis","volume":"23","author":"Maamari","year":"2023","journal-title":"Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e17875","DOI":"10.1016\/j.heliyon.2023.e17875","article-title":"Cervical spine spondylodiscitis: Review of literature on current treatment strategies","volume":"9","author":"Treffy","year":"2023","journal-title":"Heliyon"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00701-018-3467-2","article-title":"Management of spinal infection: A review of the literature","volume":"160","author":"Lener","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00264-011-1425-1","article-title":"Treatment of spondylodiscitis","volume":"36","author":"Zarghooni","year":"2012","journal-title":"Int. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2787","DOI":"10.1007\/s00586-013-2850-1","article-title":"Spinal infection: State of the art and management algorithm","volume":"22","author":"Duarte","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2018.10.FOCUS18463","article-title":"Spontaneous spondylodiscitis: Review, incidence, management, and clinical outcome in 44 patients","volume":"46","author":"Waheed","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2014.6.FOCUS14127","article-title":"Medical and surgical management of spinal epidural abscess: A systematic review","volume":"37","author":"Arko","year":"2014","journal-title":"Neurosurg. Focus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00132-012-1920-0","article-title":"Systemic and local antibiotic therapy of conservative and operative treatment of spondylodiscitis","volume":"41","author":"Fleege","year":"2012","journal-title":"Orthopade"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Li, Y.D., Wong, C.B., Tsai, T.T., Lai, P.L., Niu, C.C., Chen, L.H., and Fu, T.S. (2018). Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis. BMC. Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3377-1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2018.10.FOCUS18464","article-title":"Anterior cervical spine surgery for the treatment of subaxial cervical spondylodiscitis: A report of 30 consecutive patients","volume":"46","author":"Burkhardt","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e480","DOI":"10.1016\/j.wneu.2024.08.156","article-title":"One-stage surgical management for cervical pyogenic spondylodiscitis by anterior debridement, reconstruction, and instrumentation: A single-center experience","volume":"191","author":"Gao","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E30","DOI":"10.1097\/BRS.0b013e31821bfdb2","article-title":"Surgical treatment of cervical spondylodiscitis: A review of 30 consecutive patients","volume":"37","author":"Shousha","year":"2012","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s00586-014-3672-5","article-title":"Cervical spondylodiscitis: Change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature","volume":"24","author":"Shousha","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3171\/spi.2006.5.5.392","article-title":"Cervical spine epidural abscess: Experience with microsurgical treatment in eight cases","volume":"5","author":"Muzii","year":"2006","journal-title":"J. Neurosurg. Spine"},{"key":"ref_37","first-page":"e17747","article-title":"Three-staged surgical strategy as a combined approach for multilevel cervical pyogenic spondylodiscitis","volume":"13","author":"Mutoh","year":"2021","journal-title":"Cureus"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1007\/s00586-006-0191-z","article-title":"Surgical treatment of spondylodiscitis in the cervical spine: A minimum 2-year follow-up","volume":"15","author":"Heyde","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/BRS.0000000000003298","article-title":"Anterior cervical debridement and fusion for cervical pyogenic spondylodiscitis: Use of anterior cervical plating or not?","volume":"45","author":"Kim","year":"2020","journal-title":"Spine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1177\/21925682221145603","article-title":"An assessment of the safety of surgery and hardware placement in de-novo spinal infections. A systematic review and meta-analysis of the literature","volume":"13","author":"Pluemer","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e562","DOI":"10.1016\/j.wneu.2018.08.129","article-title":"Cervical spine osteomyelitis: A systematic review of instrumented fusion in the modern era","volume":"120","author":"Wang","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_42","first-page":"64","article-title":"Instrumented fusion in the setting of primary spinal infection","volume":"61","author":"Bydon","year":"2017","journal-title":"J. Neurosurg. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s00701-003-0129-8","article-title":"Internal fixation for osteomyelitis of cervical spine: The issue of persistence of culture positive infection around the implants","volume":"145","author":"Shad","year":"2003","journal-title":"Acta Neurochir."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3175","DOI":"10.1007\/s00586-023-08065-w","article-title":"Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: A systematic review and meta-analysis","volume":"33","author":"Maddy","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.clineuro.2013.11.029","article-title":"Cervical spondylodiscitis\u2014A clinical analysis of surgically treated patients and review of the literature","volume":"117","author":"Ozkan","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1007\/s00586-009-1265-5","article-title":"PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: A preliminary report on a patient series","volume":"19","author":"Walter","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s00701-009-0486-z","article-title":"PEEK cage cervical ventral fusion in spondylodiscitis","volume":"151","author":"Mondorf","year":"2009","journal-title":"Acta Neurochir."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e495","DOI":"10.1016\/j.wneu.2021.04.064","article-title":"The surgical treatment of pyogenic spondylodiscitis using carbon-fiber-reinforced polyether ether ketone implants: Personal experience of a series of 81 consecutive patients","volume":"151","author":"Burkhardt","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1007\/s00701-016-2924-z","article-title":"Safety and efficacy of polyetheretherketone (PEEK) cages in combination with posterior pedicel screw fixation in pyogenic spinal infection","volume":"158","author":"Shiban","year":"2016","journal-title":"Acta Neurochir."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.clineuro.2014.09.027","article-title":"Application of titanium and polyetheretherketone cages in the treatment of pyogenic spondylodiscitis","volume":"127","author":"Schomacher","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"123665","DOI":"10.1016\/j.wneu.2025.123665","article-title":"Letter to the editor regarding Does bone preservation at the anterior edge of the vertebral body affect the subsidence of zero-profile cages after anterior cervical discectomy and fusion?","volume":"195","author":"Simone","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"23094990211019101","DOI":"10.1177\/23094990211019101","article-title":"Spondylodiscitis treated with freeze-dried bone allograft alone or combined with autograft: A randomized and blinded trial","volume":"29","year":"2021","journal-title":"J. Orthop. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3340\/jkns.2011.50.4.348","article-title":"The safety and efficacy of cadaveric allografts and titanium cage as a fusion substitutes in pyogenic osteomyelitis","volume":"50","author":"Kim","year":"2011","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jocn.2021.11.018","article-title":"BMP use in the surgical treatment of pyogenic spondylodiscitis: Is it safe?","volume":"95","author":"Tee","year":"2022","journal-title":"J. Clin. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00264-011-1441-1","article-title":"Surgical treatment of spondylodiscitis. An update","volume":"6","author":"Guerado","year":"2012","journal-title":"Int. Orthop."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00586-015-4318-y","article-title":"Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: A systematic literature review","volume":"25","author":"Rutges","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"269","DOI":"10.5152\/dir.2021.20189","article-title":"CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis","volume":"27","author":"Tomita","year":"2021","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1302\/0301-620X.101B1.BJJ-2018-0869.R1","article-title":"The outcome following spinal instrumentation in haemodialyzed patients with pyogenic spondylodiscitis","volume":"101","author":"Kim","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Lim, J.S., and Kim, T.H. (2022). Recurrence rates and its associated factors after early spinal instrumentation for pyogenic spondylodiscitis: A nationwide cohort study of 2148 patients. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123356"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jocn.2019.06.040","article-title":"Outcomes and risk factors for spontaneous spondylodiscitis: Case series and meta-analysis of the literature","volume":"68","author":"Giordan","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.spinee.2014.06.010","article-title":"Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses?","volume":"15","author":"Alton","year":"2015","journal-title":"Spine J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1007\/s00586-012-2614-3","article-title":"Failure modes in conservative and surgical management of infectious spondylodiscitis","volume":"22","author":"Valancius","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1016\/j.spinee.2013.10.011","article-title":"Independent predictors of failure of nonoperative management of spinal epidural abscesses","volume":"14","author":"Kim","year":"2014","journal-title":"Spine J."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Kilinc, F., Setzer, M., Gessler, F., Prinz, V., Jussen, D., Czabanka, M., Freiman, T., and Behmanesh, B. (2025). Key Predictors of treatment failure in conservatively managed spondylodiscitis: A long-term retrospective cohort study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061973"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s15010-021-01642-5","article-title":"Influence of microbiological diagnosis on the clinical course of spondylodiscitis","volume":"49","author":"Stangenberg","year":"2021","journal-title":"Infection"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3855\/jidc.12260","article-title":"Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years\u2019 intensive care experience","volume":"14","author":"Milosevic","year":"2020","journal-title":"J. Infect. Dev. Ctries"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Widdrington, J.D., Emmerson, I., Cullinan, M., Narayanan, M., Klejnow, E., Watson, A., Ong, E.L.C., Schmid, M.L., Price, D.A., and Schwab, U. (2018). Pyogenic spondylodiscitis: Risk factors for adverse clinical outcome in routine clinical practice. Med. Sci., 6.","DOI":"10.3390\/medsci6040096"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1007\/s00701-019-03985-3","article-title":"Treatment considerations for cervical and cervicothoracic spondylodiscitis associated with esophageal fistula due to cancer history or accidental injury: A 9-patient case series","volume":"161","author":"Janssen","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1016\/j.wneu.2020.02.103","article-title":"Should be the Presence of spondylodiscitis alter the surgical treatment of patients with symptomatic ventral cervical epidural abscesses? An institutional analysis","volume":"138","author":"Tonetti","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.3171\/2014.6.FOCUS14261","article-title":"The indications and timing for operative management of spinal epidural abscess: Literature review and treatment algorithm","volume":"37","author":"Tuchman","year":"2014","journal-title":"Neurosurg. 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