Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature

Lotfinia, Iraj; Vahedi, Payman

doi:10.1007/s00586-010-1420-z

Cited by 7 publications

(5 citation statements)

References 39 publications

(80 reference statements)

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“…Two of these reported cases were diagnosed three months after the index procedure [25,26]. Lotfinia et al [15] reported a case in 2010 of late-onset postdiscectomy tuberculosis at the same lumbar level eight years after simple L4-L5 discectomy. The features of this disc tuberculosis infection are the difficulty of diagnosis, with nonspecific clinical signs and culture and the duration of the treatment.…”

Section: Postoperative Tuberculosis Spondilodiscitismentioning

confidence: 99%

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Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

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Introduction Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition. Materials and methods A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis. Results We found that the principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilise the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple cultures of bone and soft tissue, perform a thorough debridement of infected tissue, decompress neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Conclusions Appropriate management requires aggressive medical treatment and, at times, surgical intervention. If recognised early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome. A review of the literature was done to advance our understanding of the diagnosis, treatment, prevention and outcome of these infections.

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Section: Postoperative Tuberculosis Spondilodiscitismentioning

confidence: 99%

“…High rates of infection have been observed in elderly patients and spine trauma patients [13][14]. Obesity has also been quoted as a risk factor by many [15][16][17].…”

Section: Incidencementioning

confidence: 99%

Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

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“…In our series Mycobacterium tuberculosis (MTB) was present in 1 case. Three cases of POS due to MTB are reported in English literature [51][52][53]. It was noted that the cases of MTB culture-positive cases in our series were operated at rural centers for the index LDH surgery, based on poor quality MRI images of 0.5 Tesla machines.…”

Section: Discussionmentioning

confidence: 96%

Postoperative Lumbar Spondylodiscitis Following Transforaminal Endoscopy and Outcomes of Transforaminal Lumbar Interbody Fusion

Krishnan¹,

Chauhan²,

Degulmadi³

et al. 2023

J Minim Invasive Spine Surg Tech

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Objective: To describe the presentation spectrum of postoperative spondylodiscitis (POSe) following transforaminal endoscopic lumbar discectomy and to report the outcomes of transforaminal lumbar interbody fusion (TLIF).Methods: This study analyzed all patients with the classic features of POSe who underwent index surgery elsewhere and presented to us. They had not responded to conservative care for 3 weeks and were operated further with open TLIF. The treatment response was judged by the declining values of inflammatory markers, improvements in mobility, and decreases in pain. Patients’ outcomes were analyzed using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the occurrence of complications. Radiological outcomes were assessed by fusion and implant stability. The spectrum of the demographic presentation was analyzed. PubMed was searched to find the incidence of POSe and the spectrum of organisms involved.Results: Fifteen patients were operated primarily by interventionalists and four by surgeons among 19 POSe patients who finally underwent TLIF at Stavya Spine Hospital & Research Institute. Organism culture positivity was found in 10 and no culture results were present in 9 cases. All TLIF cases had a follow-up of 52.94 ± 13.66 months (range, 28–71 months). The preoperative back pain VAS improved from 9.47 ± 0.61 (8–10) to 0.42 ± 0.50 (0–1). The leg pain VAS improved from 5.78 ± 4.19 (6–10) to 0.52 ± 0.61 (0–1). The preoperative ODI improved from 87.01 ± 7.70 (73.33–97.79) to 7.36 ± 8.14 (0–26.67). No major complications occurred. Cure of infection and stable reconstruction with fusion were achieved in all patients.Conclusion: POSe has a very low reported incidence. Standardization of training and sterilization would further reduce its incidence. However, aggressive early TLIF in patients with nonresponding POSe produces beneficial results.

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“…Late-onset spondylodiscitis and psoas abscess 5 years after percutaneous balloon kyphoplasty have been reported [11]. Late tuberculous spondylodiscitis 8 years after discectomy was described by Lotfinia and Vahedi [12]. Besides these long duration periods; no case of spondylodiscitis 9 years after posterior spine surgery has been described so far.…”

Section: Discussionmentioning

confidence: 99%

A case of late-onset spondylodiscitis within the longest duration: 9 years after posterior instrumentation

Kurtulus

Başkurt²,

Yavuz

et al. 2022

Egypt J Neurosurg

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Background Spondylodiscitis is infections of the intervertebral disc and adjacent vertebral body with insidious onset. These infections are primarily haematogenous in origin. Early spinal infections after posterior spinal instrumentation usually occur within 3 months after surgery, whereas late infections may occur up to 8 years after surgery but are rare with an incidence of 1.9%. Case presentation We describe the case of a 66-year-old woman who complained of febrile back pain and developed late-onset spondylodiscitis 9 years after pedicle screw fixation, which is the longest-onset case. She was treated with surgical instrument removal and thorough debridement of the infected tissue with long-term antimicrobial treatment, with excellent results. Conclusions If there is radiculopathy and fever associated with spinal surgery in the history, it should be remembered that evaluation of lumbar spine MRI and acute phase reactions is crucial, and spondylodiscitis should also be considered in the preliminary diagnosis even after 9 years.

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Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature

Cited by 7 publications

References 39 publications

Postoperative spondilodiscitis

Postoperative spondilodiscitis

Postoperative Lumbar Spondylodiscitis Following Transforaminal Endoscopy and Outcomes of Transforaminal Lumbar Interbody Fusion

A case of late-onset spondylodiscitis within the longest duration: 9 years after posterior instrumentation

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