Introduction of antibiotics in the last century and recent progress in surgical techniques have significantly reduced mortality and morbidity rates of spondylodiscitis. However, when unrecognized, it can have catastrophic consequences for the patient. Antibiotic drugs remain the cornerstone of treatment, and surgery is to be discussed in general as a last resource in case of acute neurologic deficit or severe sagittal or frontal spinal imbalance. Metallic implants are not absolutely contraindicated in surgical treatment of spondylodiscitis and relapse of infection has been reported to be rare. In case of severe mechanical instability and neurologic deficit, they even are indispensable and complications can be avoided by accurately identifying the germ and by treating infection with the adequate antibiotic beforehand.