From Culture to Sequencing: Evolving Strategies for the Diagnosis of Pediatric Spondylodiscitis.

Pediatric spondylodiscitis is a rare but clinically significant infection affecting the intervertebral disc and adjacent vertebral bodies. Diagnostic delays are common due to its nonspecific presentation and the limited sensitivity of conventional microbiological methods. Early and accurate pathogen identification is essential to guide antimicrobial therapy, minimize unnecessary invasive procedures, and prevent long-term sequelae. Traditional diagnostic tools-including laboratory tests, imaging, blood cultures, biopsy, and histopathological evaluation-remain fundamental but are often insufficient, as they may yield nonspecific results or culture-negative cases, particularly after prior antibiotic exposure or infection with fastidious organisms. In recent years, molecular approaches, ranging from polymerase chain reaction assays to metagenomic next-generation sequencing, have markedly improved diagnostic accuracy. These techniques allow rapid and comprehensive pathogen detection, including atypical or previously uncultivable organisms, thereby overcoming many limitations of conventional methods. This narrative review synthesizes current evidence on pediatric spondylodiscitis, outlining its epidemiology, clinical features, and the evolving spectrum of diagnostic strategies-from conventional methods to advanced molecular and sequencing-based technologies-while discussing future directions in this challenging field.