Conservative versus operative management of postoperative lumbar discitis

Abstract

Background: Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis. Aim: The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy. Methods: We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis. Results: VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t -test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up. Conclusions: Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.

Combination Use of Antibiotic-Loaded Calcium Sulfate Beads in Spinal Surgery for Patients with Spondylodiscitis：A Clinical Retrospective Study

“…The mechanical strength of CS is comparable to cancellous bone, and is hydrolyzed slowly in bone, lasting for about 6-12 weeks [34]. The antibiotic-loaded beads demonstrated high bioactivity in preventing and eliminating the residual bacteria, with long periods of sustained e cacy [37]. It's a good solution for the shortcoming of insu cient removal of infected tissue in the posterior procedure.…”

“…After sending blood culture and disc space aspiration, all patients immediately started empirical intravenous antimicrobial therapy. Then, an appropriate antibiotic was administrated according to the results of microbial culture and sensitivity [37].…”

Antibiotic-loaded calcium sulfate beads in spinal surgery for patients with spondylodiscitis: a clinical retrospective study

“…After sending blood culture and disc space aspiration, all patients immediately started empirical intravenous antimicrobial therapy. Then, an appropriate antibiotic was administrated according to the results of microbial culture and sensitivity [ 38 ].…”

Spinal Epidural varicosity resembling prolapsed intervertebral disc on MRI: A diagnostic dilemma for lumbar canal stenosis

“…Radiologically may resemble herniated disc, such diagnostic dilemma of canal stenosis on radiology may be surprising intraoperatively sometimes like in our case. [4][5][6][7][8][9] Every neurosurgeon should be careful regarding this issue that all radiculopathy or neurogenic claudication are not due to herniated disc which resembles like disc on MRI.…”