Spinal infections caused by Mycobacterium abscessus are rare and difficult to treat. We report the first case of M. abscessus subsp. massiliense spondylodiscitis temporally associated with spinal anesthesia. A 57-year-old man developed back pain after undergoing spinal anesthesia for prostate surgery. Six months later, decompressive laminectomy was performed; results for bacterial and fungal culture and molecular testing for Mycobacterium tuberculosis were negative. Two years later, a mycobacterial culture of material from a paravertebral abscess revealed the presence of M. abscessus, later identified as subsp. massiliense. Treatment with imipenem, amikacin, tigecycline, clofazimine, and clarithromycin resulted in clinical and radiological improvement. This report highlights the diagnostic and therapeutic challenges of this case.

Brucellosis is a zoonotic infection that affects the spine, typically presenting as spondylodiscitis. Predominantly, epidural involvement without significant concurrent disc or vertebral involvement is rare and may closely mimic non-infectious pathologies. We report a man in his 50s presenting with low back pain and lower limb radiculopathy. Initial MRI demonstrated an epidural-predominant ventral epidural collection at L4-L5 associated with a posterior annular fissure, without significant vertebral or disc involvement, mimicking a sequestered disc fragment. Diffusion-weighted imaging showed peripheral restriction, and post-contrast imaging demonstrated thick rim enhancement, favouring infection. Follow-up MRI at 10 days revealed new vertebral marrow oedema consistent with evolving spondylodiscitis. Blood cultures confirmed Brucella species. Despite antibiotic therapy, progressive neurological and radiological deterioration necessitated surgical decompression. Histopathology confirmed an infected epidural collection. This case illustrates a rare epidural-first presentation of spinal brucellosis and highlights MRI discriminators and the role of short-interval follow-up imaging in diagnostically challenging epidural lesions.

Pott's disease, also known as tuberculous spondylodiscitis, accounts for 50% of all forms of skeletal tuberculosis. It is rare in children, especially in low-burden TB countries. We present a case of Pott's disease with miliary tuberculosis in a 22-month-old child. Furthermore, we provide an exploratory literature review of pediatric cases published in PubMed and Scopus between January 2000 and August 2025, including patients aged 0 to 17 years with confirmed or clinically diagnosed tuberculous spondylodiscitis. Sixty-four cases were included. Most cases (81.3%) involved children from highly endemic countries, particularly India. Median age was 10 years, with a median diagnostic delay of 141.4 days. The most common signs and symptoms were back pain (79.6%), followed by difficulty walking (68.4%). The thoracic spine was the most affected segment (60.3%). Sixty-three received anti-TB therapy, 58% required surgical intervention, and treatment led to overall clinical recovery in 96.9% of cases. Neurological deficits were reported in 46% (paresthesia) and 68.4% (motor weakness), with permanent motor sequelae in 8.1% and persistent spinal deformity (kyphosis) in 14.5%. Our case highlights the importance of considering the suspicion of tuberculous spondylodiscitis, even in low-endemic countries, to achieve early diagnosis and appropriate therapeutic management. Early MRI combined with microbiological confirmation is essential to reduce the risk of severe complications, including neurological sequelae, progressive spinal deformities, and potentially life-threatening outcomes in growing patients.

Spondylodiscitis is a rare complication of pediatric button battery (BB) ingestion with 12 reported cases. Delayed BB removal tends to be the underlying scenario. A posteriorly oriented BB anode on radiographs may also be a pattern seen in these cases. We report the case of a 2-year-old male with chronic intermittent upper respiratory symptoms, initially managed expectantly, without imaging. The child had no neurological symptoms or neck pain. Five months after symptom onset, radiographs unexpectedly revealed an esophageal BB with a posteriorly oriented anode. Emergent endoscopic removal was performed, and multiple BB-related complications were identified. CT and MRI demonstrated T2-T4 spondylodiscitis with chronic osseous bridging. The child was treated with IV antibiotics and was without related clinical sequelae 1 year later. While rare, spondylodiscitis should be sought out in cases of delayed BB removal. Since the absence of neurologic symptoms may not reliably exclude spondylodiscitis, the diagnosis heavily relies upon imaging. CT and MRI both play key roles, but MRI of the cervical and thoracic spine is the study of choice. Radiologists can play a key role in early diagnosis by being familiar with this unique entity.

Vertebral osteomyelitis and spondylodiscitis are uncommon but potentially life-threatening infections that may present with non-specific symptoms, resulting in delayed diagnosis. We report the case of a 65-year-old man who presented with acute low back pain, high-grade fever, confusion, and transient neurological symptoms. Initial investigations demonstrated markedly elevated inflammatory markers and persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. A CT of the head and thorax/abdomen/pelvis, transthoracic echocardiography, and an early whole-spine MRI study failed to identify the source of infection. Despite appropriate intravenous antimicrobial therapy, the patient remained bacteraemic with persistent back pain, prompting repeat MRI, which demonstrated L5-S1 spondylodiscitis complicated by an anterior epidural abscess causing cauda equina compression and an associated prevertebral collection. As the patient remained neurologically intact, a multidisciplinary team involving microbiology, radiology, cardiology, and spinal surgery agreed on conservative management with prolonged intravenous flucloxacillin. The patient demonstrated progressive clinical improvement with resolution of fever, declining inflammatory markers, preserved neurological function, and successful discharge to complete outpatient parenteral antimicrobial therapy. This case highlights the importance of maintaining a high index of suspicion for vertebral infection in patients with persistent S. aureus bacteremia (SAB) and ongoing back pain despite initially negative imaging. It also emphasises the value of repeat MRI when clinical suspicion persists and demonstrates that carefully selected patients with spinal epidural abscess may be successfully managed without surgery through a multidisciplinary approach.

This single-patient case report describes an all-posterior salvage reconstruction of multilevel lumbar osteomyelitis using a stand-alone hydrophilic synthetic bone graft (HPSBG; OsteoFlo® HydroFiber™, SurGenTec, LLC, Boca Raton, FL) packed transpedicularly as the sole intervertebral graft material. Postoperative osteomyelitis with progressive vertebral body destruction commonly involves combined anterior-posterior reconstruction with corpectomy and structural cage placement, which is technically demanding and morbid in patients with poor bone quality and adjacent prior fractures. Hydrophilic synthetic bone grafts engineered to support fusion in compromised environments may permit less invasive salvage strategies. A 59-year-old woman with persistent L1-L2 osteomyelitis after a prior L2-L5 fusion for an L3 burst fracture, complicated by osteoporosis and low vitamin D levels (25-hydroxyvitamin D 15.6 ng/mL), underwent posterior-only salvage reconstruction. Through an all-posterior approach, transpedicular partial corpectomies of L1 and L2 were performed through the existing erosive defects. Intraoperative cultures grew Pseudomonas aeruginosa. The void was packed with HPSBG as the sole intervertebral graft material, with no anterior cage. Long-segment T10-pelvis fixation with a quad-rod construct provided posterior stabilisation. Computed tomography (CT) at eight months postoperatively demonstrated bridging bone through the L1-L2 defect, consistent with early anterior column consolidation, and repeat CT at 12 months showed bridging trabecular bone across the defect with continuity to the host endplates. Patient-reported outcomes improved at 12 months, and the patient returned to her preoperative activities. This case suggests that a stand-alone hydrophilic synthetic graft may support anterior column consolidation when used without an interbody cage in an infected, biologically hostile environment, potentially reducing the need for morbid anterior reconstruction in selected salvage cases. Larger comparative studies are warranted.

A 77-year-old patient presents with acute back pain. Due to elevated CRP and other lab abnormalities, bacterial spondylodiscitis is initially suspected, and blood cultures are obtained early. However, a biopsy reveals uric acid crystals and cultures remain negative, leading to the diagnosis of gout spondylodiscitis. Treatment includes renal-adjusted anti-inflammatory therapy, urate-lowering therapy and flare prophylaxis.