Intervertebral Disc Infection after Lumbar Chemonucleolysis: Report of a Case

Abstract

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.

Fulminating Septicemia Secondary to Oxygen-Ozone Therapy for Lumbar Disc Herniation

“…Even when aseptic techniques are used, epidural and spinal needles can become contaminated with a variety of organisms that may introduce pathogens into the muscles, soft tissue, and epidural space, and lead to clinical infection. 22,27 Trauma to the tissues with secondary bleeding can create a favorable site for bacterial adherence and multiplication. Several routes might be possible for the introduction of microorganisms into soft tissue.…”

Postoperative Spinal Wound Infections and Postprocedural Diskitis

“…In general, the invasiveness or complexity of the procedure is directly related to the infectious complication rate. Postprocedural diskitis has been reported after a plethora of spinal interventions including less invasive procedures such as diskography (33), chemonucleosis (34,35), myelography (36), paraspinal injections, lumbar punctures, and epidural injections. Diskectomy has infection rates ranging from 0.6% to 5% (1,37).…”

Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain

“…Silber et al (649) described that it is a rare complication after any invasive procedure on the spine with an incidence of 0.2%. However, post procedure discitis represents 30.1% of all cases of pyogenic discitis and has been reported after almost every open and minimally invasive surgical procedure, including laminectomies, discectomies, fusions with or without instrumentation and less invasive procedures, such as discography, chemonucleolysis, myelography, paravertebral injections, and lumbar puncture (649)(650)(651)(652)(653)(654)(655)(656). Similar to postoperative vertebral osteomyelitis, post procedural discitis frequently affects the elderly and immunocompromised and is an important cause of postoperative back pain in the spine patient.…”