Spondylodiscitis and vertebral osteomyelitis can lead to long-term sequelae if not diagnosed and treated promptly and appropriately. The Royal National Orthopaedic Hospital (RNOH) has devised a new spinal infection referral system within the UK that allows cases to be discussed in a specialist multi-disciplinary (MDT) forum. National guidelines were devised in 2013 to help guide treatment, which recommends both tissue biopsies from the affected region and a MRI of the entire spine. The aims of this study were to assess the current treatment and referral practices and compare them with the set guidelines. It is hypothesised that a high percentage of patients are started on antibiotics without a biopsy or a positive set of blood cultures, a low percentage of patients are referred without undergoing a MRI of the full spine and that there is a long delay in referral to the MDT. A retrospective case study analysis was carried out on all spinal infection referrals received by the Royal National Orthopaedic Hospital over a 2-year period (2014–16), using the standards set by the current national guidelines. Clinical features, haematology results, imaging, biopsy results, treatment and outcome were all reviewed. Three key areas were addressed; whether antibiotics were commenced before positive cultures or biopsy, whether a MRI of the entire spine was performed and the time taken for referral from the onset of symptoms.Aim
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