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This retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis aimed to assess how biopsy results impact clinical management. It was found that biopsy results changed management in 36% of cases, mostly in culture-positive cases allowing for customizing antibiotic treatment. While antibiotic therapy at the time of biopsy did not impact yield, it was concluded that it may lead to less management change.