Aim: To effect a retrospective review of all patients who presented with discitis at Auckland Hospital between 1990 and 1998 for the purpose of delineating the indications for surgery and to establish guidelines for treatment of those patients where a pathogen was not isolated.

Method: The clinical, laboratory and radiological findings were reviewed. Where possible, patients underwent telephone interviews.

Results: Thirty-one patients were reviewed. Two patients had died. The clinical picture was characterised by back pain, point tenderness, spasm, radiculopathy, fevers and chills. The average time between clinical presentation and diagnosis was 11 weeks. The ESR was consistently elevated at the time of presentation and it was indicative of disease activity. A causative pathogen was isolated in 28 patients. Mixed pathogens were uncommon. Seven patients required operative debridement and five needed orthotic supports. A spectrum of imaging modalities was used. Particular attention to MRI in support of the diagnosis was critically reviewed.

Conclusions: Non operative management along with chemotherapy specific to the pathogen remains the main stay of treatment for patients with discitis. An algorithm for treatment is recommended including indications for surgery and guidelines for empirical treatment where a causative pathogen is not isolated.