Infectious spondylodiscitis is increasingly prevalent in the elderly population. Despite modern imagery techniques, time between onset of symptoms and diagnosis is still important and directly affects mortality rate. The systematic use of red flags for back pain patients should be able to improve this situation. In case of clinical and radiological suspicion of infectious spondylodiscitis, every effort should be directed toward the characterization of the bacteria before the introduction of antibiotics. Most of the time conservative treatment with antibiotics and bracing is appropriate but in selected cases a surgical procedure is advised, specifically in case of severe motor deficit or in the presence of non-tuberculosis abscess.