A Retrospective Analysis of the Management of Postoperative Discitis: A Single Institutional Experience

Overview

Journal Asian Spine J

Date 2015 Aug 5

PMID 26240715

Citations 10

Authors

R Santhanam

K Lakshmi

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective study.

Purpose: The aim of the study was to study the impact and outcome of conservative management and surgical intervention in cases of postoperative discitis.

Overview Of Literature: Postoperative discitis is a rare but often misdiagnosed cause of failed back syndrome. There is paucity of literature regarding management guidelines of postoperative discitis.

Methods: The study was carried out over a period of 6 years. Eighteen patients with postoperative discitis were included in the study.

Results: Conservative management with antibiotics, analgesics and bed rest were started in all the study cases. Posterior transpedicular fixation after re-exploration debridement and curettage of disc space granulation tissue was conducted in five patients in whom conservative management failed.

Conclusions: Early diagnosis and appropriate management is the key to effective treatment of postoperative discitis. Conservative management leads to excellent results in majority of cases. Surgical intervention with posterior interbody fusion and debridement is helpful when conservative treatment fails.

Citing Articles

Early Intervention in Post-operative Infectious Spondylodiscitis: Outcome of Aggressive Transforaminal Lumbar Interbody Fusion.

Krishnan A, Dave B, Degulmadi D, Mayi S, Rai R, Bang P Malays Orthop J. 2024; 18(3):16-26.

PMID: 39691573 PMC: 11647542. DOI: 10.5704/MOJ.2411.003.

Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm.

Chaniotakis C, Koutserimpas C, Tsantes A, Papadopoulos D, Tsiridis C, Karantanas A J Clin Med. 2024; 13(5).

PMID: 38592315 PMC: 10935210. DOI: 10.3390/jcm13051478.

Ralstonia mannitolilytica as a rare cause of spondylodiscitis following endoscopic lumbar discectomy- A report of two cases.

Ramachandran K, Shetty A, Shanmuganathan R J Clin Orthop Trauma. 2023; 42:102205.

PMID: 37529546 PMC: 10388582. DOI: 10.1016/j.jcot.2023.102205.

Discitis Following Radiofrequency Nucleoplasty: A Case Report.

Shofwan S, Liem L, Janitra G, Basuki N, Rhatomy S Anesth Pain Med. 2021; 10(6):e110322.

PMID: 34150577 PMC: 8207849. DOI: 10.5812/aapm.110322.

Conservative versus operative management of postoperative lumbar discitis.

Ahsan K, Hasan S, Khan S, Zaman N, Almasri S, Ahmed N J Craniovertebr Junction Spine. 2020; 11(3):198-209.

PMID: 33100770 PMC: 7546051. DOI: 10.4103/jcvjs.JCVJS_111_20.

References

Wirtz D, Genius I, Wildberger J, Adam G, Zilkens K, Niethard F . Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis--an evaluation of 59 cases. Arch Orthop Trauma Surg. 2000; 120(5-6):245-51. DOI: 10.1007/s004020050457. View

Sharma S, Jones J, Zeballos P, Irwin S, Martin T . The prevention of discitis during discography. Spine J. 2009; 9(11):936-43. DOI: 10.1016/j.spinee.2009.06.001. View

Frank A, Trappe A . The role of magnetic resonance imaging (MRI) in the diagnosis of spondylodiscitis. Neurosurg Rev. 1990; 13(4):279-83. DOI: 10.1007/BF00346365. View

Lecouvet F, Irenge L, Vandercam B, Nzeusseu A, Hamels S, Gala J . The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis. Arthritis Rheum. 2004; 50(9):2985-94. DOI: 10.1002/art.20462. View

Fouquet B, Goupille P, Jattiot F, Cotty P, Lapierre F, Valat J . Discitis after lumbar disc surgery. Features of "aseptic" and "septic" forms. Spine (Phila Pa 1976). 1992; 17(3):356-8. DOI: 10.1097/00007632-199203000-00019. View

Silber J, Anderson D, Vaccaro A, Anderson P, McCormick P . Management of postprocedural discitis. Spine J. 2003; 2(4):279-87. DOI: 10.1016/s1529-9430(02)00203-6. View

Boden S, DAVIS D, Dina T, Sunner J, Wiesel S . Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disk space changes. Radiology. 1992; 184(3):765-71. DOI: 10.1148/radiology.184.3.1509065. View

Rawlings 3rd C, Wilkins R, Gallis H, Goldner J, Francis R . Postoperative intervertebral disc space infection. Neurosurgery. 1983; 13(4):371-6. DOI: 10.1227/00006123-198310000-00004. View

Luzzati R, Giacomazzi D, Danzi M, Tacconi L, Concia E, Vento S . Diagnosis, management and outcome of clinically- suspected spinal infection. J Infect. 2009; 58(4):259-65. DOI: 10.1016/j.jinf.2009.02.006. View

10.

Rayes M, Colen C, Bahgat D, Higashida T, Guthikonda M, Rengachary S . Safety of instrumentation in patients with spinal infection. J Neurosurg Spine. 2010; 12(6):647-59. DOI: 10.3171/2009.12.SPINE09428. View

11.

Perronne C, Saba J, Behloul Z, Salmon-Ceron D, Leport C, Vilde J . Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clin Infect Dis. 1994; 19(4):746-50. DOI: 10.1093/clinids/19.4.746. View

12.

Fraser R, Osti O, Vernon-Roberts B . Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. Spine (Phila Pa 1976). 1989; 14(9):1025-32. DOI: 10.1097/00007632-198909000-00018. View

13.

Kapp J, Sybers W . Erythrocyte sedimentation rate following uncomplicated lumbar disc operations. Surg Neurol. 1979; 12(4):329-30. View

14.

Przybylski G, Sharan A . Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg. 2001; 94(1 Suppl):1-7. DOI: 10.3171/spi.2001.94.1.0001. View

15.

Van Goethem J, Parizel P, van den Hauwe L, Van de Kelft E, Verlooy J, De Schepper A . The value of MRI in the diagnosis of postoperative spondylodiscitis. Neuroradiology. 2000; 42(8):580-5. DOI: 10.1007/s002340000361. View

16.

Levi A, Dickman C, Sonntag V . Management of postoperative infections after spinal instrumentation. J Neurosurg. 1997; 86(6):975-80. DOI: 10.3171/jns.1997.86.6.0975. View

17.

Rohde V, Meyer B, Schaller C, Hassler W . Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis. Spine (Phila Pa 1976). 1998; 23(5):615-20. DOI: 10.1097/00007632-199803010-00016. View

18.

Jimenez-Mejias M, de Dios Colmenero J, Sanchez-Lora F, Palomino-Nicas J, Reguera J, Garcia de la Heras J . Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis. 1999; 29(2):339-45. DOI: 10.1086/520212. View

19.

Mann S, Schutze M, Sola S, Piek J . Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus. 2005; 17(6):E3. DOI: 10.3171/foc.2004.17.6.3. View

20.

Onik G . Automated percutaneous biopsy in the diagnosis and treatment of infectious discitis. Neurosurg Clin N Am. 1996; 7(1):145-50. View