Overview
Sacral infections can refer to infections associated with sacral neuromodulation devices or spondylitis affecting the sacrum. Sacral neuromodulation is used for various lower urinary tract and bowel dysfunction indications 1. Spondylitis is an inflammation of the vertebrae, which can include the sacrum 2.Diagnosis
Sacral Neuromodulation Infection: Postoperative complications including infection are monitored 1.
Sacral Spondylitis: MRI features can help differentiate tuberculous from pyogenic spondylitis 2.
* Features suggestive of tuberculous spondylitis include involvement of ≥2 vertebral bodies, epidural extension, paravertebral collection, subligamentous spread, thin and regular abscess wall, vertebral collapse, and kyphosis 2.
* Features suggestive of pyogenic spondylitis include disc signal change and disc height loss 2.
* Diagnosis is confirmed with histopathological results and/or blood culture 2.Management
Sacral Neuromodulation Infection: Infection-reducing strategies are employed to minimize postoperative complications 1.
Sacral Spondylitis: Management strategies are not detailed in the provided abstracts 2.Key Recommendations
Infection-reducing strategies should be considered for patients receiving sacroneuromodulation 1. (Evidence: Weak)
MRI features such as involvement of ≥2 vertebral bodies, epidural extension, paravertebral collection, subligamentous spread, thin and regular abscess wall, vertebral collapse, and kyphosis are more suggestive of tuberculous spondylitis compared to pyogenic spondylitis 2. (Evidence: Moderate)
MRI features such as disc signal change and disc height loss are more suggestive of pyogenic spondylitis compared to tuberculous spondylitis 2. (Evidence: Moderate)References
1 Carbone L, Rothenberger R, Houston HE, Stone SL, Lenger SM, Stuart A et al.. Infection Reducing Strategies in Sacroneuromodulation: A Systematic Review. Neurourology and urodynamics 2025. link
2 Ling-Shan C, Zheng-Qiu Z, Jing L, Rui Z, Li-Fang L, Zhi-Tao W et al.. Magnetic resonance imaging features for differentiating tuberculous from pyogenic spondylitis: a meta-analysis. Skeletal radiology 2024. link