The incidence of spondylodiscitis is highest among the elderly. Because of the ageing population the incidence of spondylodiscitis is rising. In this article, we illustrate dilemmas which may occur when treating older patients with spondylodiscitis by presenting two cases. The first patient is a 74-year-old man in whom there was uncertainty about the diagnosis on the basis of imaging results. The second patient is an 82-year-old man with dementia in whom longstanding intravenous treatment was too burdensome and treatment with oral antibiotics was started. The diagnosis of spondylodiscitis in elderly can be challenging because of frequent atypical presentation and comorbidity. So far, there is not much known about the prognosis of spondylodiscitis in the elderly, which make decisions about treatment difficult. The prognosis seems worse in elderly with multimorbidity. A comprehensive geriatric assessment can help to guide treatment decisions by estimating the chance of good functional recovery.