Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases

Abstract

Background:The established protocols of treatment of postoperative lumbar discitis have not been validated till date. We report a retrospective analysis of a series of patients with discitis following single level lumbar discectomy. We analyzed the outcome of conservative treatment of postoperative discitis with the objective to define when and what surgery was required when the conservative treatment failed.Materials and Methods:A total of 17 cases of postoperative discitis treated from 2002 to 2009 were followed up and evaluated clinically, radiologically and by laboratory investigations. All the patients were treated initially conservatively with rest and antibiotic therapy after diagnosis and those who did not respond to conservative treatment of at least 4 weeks were treated surgically. The cases were followed up with serial C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) for at least 1 year.Results:The mean followup was 40.38 months (range 12-86 months). Four cases failed to respond to conservative therapy and were treated surgically. In three of these four cases, open debridement, transpedicular fixation and posterolateral fusion was performed, and in the fourth case percutaneous transpedicular fixation was done. In the former group, one case was diagnosed to be tubercular, in another case Staphylococcus aureus was cultured where as the third case culture was sterile. All operated patients showed evidence of interbody fusion at 1 year followup.Conclusions:Early detection and aggressive treatment are paramount in managing postoperative discitis and the majority do well with conservative treatment. Surgical management in the form of transpedicular fixation and debridement, when required, gives excellent results.

Failed back surgery syndrome

“…Послеоперационный дисцит -воспалительный процесс ядра ГМД, замыкательных хрящевых пластинок, смежных кортикальных слоев тел позвонков [38]. Дисцит может быть как асептическим, так и инфекционным [39]. Дисцит и раневая инфекция встречаются у 2-3% пациентов, перенесших микродискэктомию [40].…”

Conservative versus operative management of postoperative lumbar discitis

“…Iatrogenic cause was described and usually can occur following lumbar discectomies. [ 3 ] POD incidence varies from 0.2% to 4%. [ 4 5 6 ] Such type of infections may occur either by open procedure such as laminectomy, discectomy, fusion or instrumented fusions or by minimally invasive spinal procedure such as discography, myelography, paravertebral injection, lumbar puncture etc.…”

“…[ 6 ] It can be septic or aseptic, but recent data suggest that POD is mainly septic bacterial infections. [ 3 7 ]…”

“…[ 9 10 11 ] Postoperatively, back pain usually develops (1–6 weeks). [ 3 8 ] While neurological deficits are uncommon, spinal tenderness is the most common sign detected on examination associated with restricted range of movement, pseudo-Gower sign (difficulty rising from bed), paravertebral muscle spasm, and loss of lumbar lordosis. [ 5 8 11 ] Hence, a high index of suspicion is necessary for every patient presenting with back pain after spinal surgery to start early diagnosis and treatment of discitis; otherwise, this can lead to increased morbidity and mortality.…”

“…[ 5 8 11 ] Hence, a high index of suspicion is necessary for every patient presenting with back pain after spinal surgery to start early diagnosis and treatment of discitis; otherwise, this can lead to increased morbidity and mortality. [ 3 8 12 13 ]…”