ICM 2025 first global consensus recommendations on spinal infections published in the GSJ
The new Global Spine Journal (GSJ) Focus Issue from the International Consensus Meeting (ICM) on Spinal Infections has been published. It presents a landmark set of global recommendations aimed at improving the diagnosis and management of spinal infections worldwide.
- International spine infection experts published ICM 2025 consensus recommendations on pyogenic and tubercular spinal infections in a GSJ Focus Issue.
- 132 surgeons from 32 countries reviewed 73 priority questions and developed globally validated consensus recommendations.
- Surgeons gain evidence-based guidance for diagnosis, treatment decisions, and management of spinal infections across diverse settings.
- Complete voting results, literature reviews, and consensus questions will be published through the ICM publication platform.
International experts unite to address one of spine surgery's most complex challenges
Bringing together 132 spine surgeons from 32 countries, the initiative represents one of the largest international collaborations dedicated specifically to spinal infections. The meeting held in May 2025 in Istanbul, Turkey, formed part of the broader International Consensus Meeting on Musculoskeletal Infection (ICM 2025) and focused on addressing significant variations in clinical practice across regions and healthcare systems.
The Focus Issue covers the following topics:
- Methodological Framework for Global Expert Consensus on Musculoskeletal Infection: Establishing the ICM 2025 Recommendations
- ICM 2025 (Spine Section) – List of International Delegates who formed a part of the consensus meeting
- Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part A Pyogenic Spondylodiscitis
- Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part B Tubercular Spondylodiscitis
Addressing a global clinical challenge
Spinal infections remain among the most challenging conditions encountered by spine surgeons. Delayed diagnosis can lead to neurological deterioration, spinal instability, deformity, and systemic complications. At the same time, treatment approaches often differ considerably because of variations in healthcare infrastructure, disease prevalence, access to diagnostic tools, and the limited availability of high-level evidence.
To address these challenges, participating experts developed recommendations through a structured consensus process. More than 300 clinical questions were initially proposed and subsequently prioritized to identify the most relevant topics influencing daily practice.
One of the distinguishing features of the initiative was the decision to evaluate pyogenic and tubercular spinal infections separately. Although both are commonly categorized as spinal infections, they differ substantially in disease biology, diagnosis, treatment strategies, and surgical decision-making.
"Recognizing the differences between pyogenic and tubercular infections was essential to developing recommendations that can be applied meaningfully across different regions of the world," said Professor Shanmuganathan Rajasekaran, Chair of the Spine Section of ICM 2025.
The project also emphasized transparency, systematic literature review, evidence grading, and international collaboration. Final recommendations were discussed and formally voted on during face-to-face sessions in Istanbul, providing broad international representation and validation.
A framework for future consensus building
Beyond the recommendations themselves, organizers believe the consensus process offers a valuable template for future guideline development in areas where clinical variability remains high and evidence is limited.
"The significance of this meeting extends beyond spinal infection care. It demonstrates how surgeons from around the world can work together to address important clinical questions and develop practical guidance that supports patient care globally," said Professor Cem Ali Karakus.
The consensus recommendations are expected to serve as a reference point for surgeons managing spinal infections in diverse healthcare environments while helping to establish a common framework for diagnosis, decision-making, and treatment.
The full collection of consensus questions, literature reviews, voting outcomes, and recommendations will be made available through the International Consensus Meeting publication platform.
Key facts
- 132 spine surgeons participated from 32 countries
- More than 300 clinical questions were initially submitted
- 73 high-priority questions were selected for formal review and voting
- Separate consensus pathways were developed for pyogenic and tubercular spinal infections
- The meeting took place in Istanbul, Turkey, in May 2025 as part of ICM 2025 on Musculoskeletal Infection