In the case of tuberculous SpD, the entire spinal column should be imaged during diagnosis since additional silent foci are often present. The Pola classification considers these MRI morphological aspects of SpD as well as a possible neurological deficit and is thus a possible grading system for the severity of SpD. Decreased disc height, end plate erosions or destructions, signs of paraspinal and epidural inflammation and epidural or psoas abscesses can also be detected. Typical pyogenic SpD associated MRI findings include, hyperintense intervertebral disc and/or adjacent vertebra bodies in fat suppressed T2 -weighted (w)/ short tau inversion recovery (STIR) sequence and hypointense intervertebral disc and/or bodies in T1-weigted-sequence. Magnetic resonance imaging (MRI) is the gold standard for pyogenic SpD diagnostic imaging due to its high specificity (96%) and sensitivity (92%). The non-specific clinical appearance impairs the diagnosis, especially in patients with pre-existing degenerative spinal disorders. Pyogenic SpD occurs predominantly in the lumbar spine (58%), followed by the thoracic spine (30%) and cervical spine (11%). The incidence of pyogenic spondylodiscitis (SpD) (0.2–2.4 cases per 100,000 people per year) has risen, probably due to increases in life expectancy and associated comorbidities. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen. Conclusionsĭue to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. One patient died before a planned two-stage procedure was performed. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. All patients with uSpD were treated operatively. Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). USpD was detected by MRI in 69 of 79 patients (87%). Surgical therapy was evaluated in patients with mSpD. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 20. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary.