Spondylodiscitis affects which part of the spine first in adults?

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In adults, the first target of spondylodiscitis is the anterior vertebral endplate. Blood-borne bacteria tend to seed the endplates through the vertebral arteries, making the endplate the initial site of infection. Once the endplate is involved, the infection can erode into the adjacent vertebral body, causing osseous destruction. The intervertebral disc is relatively avascular in adults, so disc involvement generally follows after the endplates and bone. Clinically and on imaging, you’d see endplate irregularity and edema first, then vertebral body destruction and disc space changes as the infection spreads. The posterior elements and spinous processes are less likely to be the initial sites because their vascular supply is different, making them less susceptible at the outset.