Conservative versus surgical management of spontaneous spondylodiscitis: a prospective randomized controlled trial (RCT)

Abstract Background The optimal management of spontaneous spondylodiscitis (SD) remains controversial, with limited randomized evidence comparing conservative antibiotic therapy versus surgical intervention. This study aimed to compare efficacy, complications, and functional outcomes of conservative versus surgical management in spontaneous SD. Methods This prospective randomized clinical trial enrolled 30 patients with spontaneous spondylodiscitis randomized equally to conservative management ( n = 15) or surgical intervention plus antibiotics ( n = 15). Primary outcomes were length of hospital stay (LOS), antibiotic duration, complications, laboratory/radiological resolution, and functional recovery (Visual Analogue Scale (VAS), MacNab criteria) assessed at 3, 6, and 12 months. Results Surgical patients had significantly shorter LOS (8 ± 2.75 vs. 38.7 ± 8.75 days, P < 0.001) and antibiotic duration (1.6 ± 1.25 vs. 3.86 ± 2.75 months, P = 0.009). Complication rates were similar (66.7% vs. 60.0%, P = 1.000). Laboratory normalization occurred in 60% conservative vs. 46.7% surgical cases ( P = 0.432); solid fusion rates were 53.3% vs. 46.7% ( P = 0.701). Both groups showed significant VAS improvement (mean 3.0 vs. 2.8, P = 0.7), with excellent-to-good MacNab outcomes in 73.3% vs. 60% ( P = 0.34). Conclusions Surgical management significantly reduces LOS and antibiotic duration while achieving comparable long-term functional outcomes to conservative treatment, suggesting early surgery as a more efficient approach for spontaneous SD.