Spondylodiscitis is a rather rare condition with an annual incidence of 1–7 per 100,000. Thus, empirical data on the treatment of this disease are limited. In 2020, the first German guideline for the diagnosis and treatment of spondylodiscitis was published. In a 5-year retrospective analysis, we examined the patient collective, the current diagnosis and treatment strategy, and the effect of Magnetic Resonance Imaging (MRI) diagnostics on therapeutic decisions of a consecutive monocentric cohort of 66 patients without neurological symptoms. The majority of the patients were male (55%) with a mean age of 74 years. Non-operative therapy was found to be associated with short-term treatment success in 54 (82%) of the patients. In 12 patients, who underwent surgical therapy, MRI diagnostics and clinical findings were equally important for the decision to perform a surgery. Patients treated operatively stayed for an average of 33.6 (±12.9) days in the hospital and thus significantly longer than non-operatively treated patients with 22.2 (±8.0) days. The in-house standard of care did not essentially deviate from the guideline’s recommendations. Future research should address early detection of the need for surgical therapy, and immediate anti-infective treatment appropriate to the detected pathogen.