Postoperative Spondylodiskitis: Etiology, Clinical Findings, Prognosis, and Comparison with Nonoperative Pyogenic Spondylodiskitis

Abstract

We studied 31 cases of postoperative pyogenic spondylodiskitis (POS), comparing them with 72 cases of nonpostoperative pyogenic spondylodiskitis (NPOS). POS represents 30.1% of cases of pyogenic spondylodiskitis. The onset of symptoms occurred an average (+/-SD) of 27.7 (+/- 25.3) days following surgery. Predisposing factors were less frequent in POS than NPOS cases (P = .002). Neurological complications and inflammatory signs in the spine were more frequent with POS than with NPOS (P = .002 and P < .00001). Coagulase-negative Staphylococcus and anaerobic bacteria were more frequent in POS than in NPOS (P = .0001 and P = .05). Percutaneous bone biopsies yielded the etiology in 66.7% of cases, open bone biopsies in 100%, blood cultures in 55.6%, and cultures of adjacent foci in 94.4%. Eleven patients (35.5%) were cured with antimicrobial treatment, but surgical treatment was necessary in 64.5%. No relapses or deaths were recorded. Seventeen patients (54.8%) had severe functional sequelae, which were associated with inflammatory signs in the spine (P = .033), higher levels of leukocytosis (P = .05), higher erythrocyte sedimentation rates (P = .05), and paravertebral abscesses (P = .04).

The etiologic diagnosis of infectious discitis is improved by amplification‐based DNA analysis

“…Timely relevant identification of the causative agents and specific antimicrobial treatment are essential for avoiding severe complications in infectious discitis (23). When pathogen identification is lacking, there is no option other than to use empirically based (trial and error), broad-spectrum, and long-term antibiotic therapy.…”

Spontaneous corynebacterium discitis in a patient with chronic renal failure

“…The incidence of spontaneous discitis has risen over the past several years due to an increase in the overall frequency of pyogenic infections. 2,3 The principle pathogenic mechanism in spontaneous discitis is hematogenous spread. In most cases, the person has health issues that make him or her susceptible to this type of infection.…”

“…In the past, granulomatous infection was the most common etiology in these cases; however, the rate of pyogenic infection has risen in parallel with increased numbers of immunocompromised patients. 2 The causal bacteria are rarely demonstrated by direct culture or biopsy, and only 30-50% of these cases show culture growth during the clinical course. 8 In one series of 1168 patients with spondylodiscitis, the most frequently isolated bacterium was Staphylococcus aureus, followed by S. albus and S. epidermidis.…”

“…Spontaneous spondylodiscitis due to C. diptheria is extremely rare, and only two cases have been reported to date. 1,2 In humans, C. diptheria comprise part of the normal flora of the skin and nasopharyngeal region. 18 We were unable to identify the focus of infection in our case; however, it Figure 2 At 10 months follow-up MRI: (a) sagittal and (b) axial postcontrast T1-weighted image with fat saturation show minimal enhancement of L5-S1 intervertebral disc (small arrow) and minimal enhancement of epidural soft tissue (large arrow).…”

“…Corynebacterium subspecies (diptheria) very rarely cause these infections, and our review of the literature revealed only two similar cases previously reported. 1,2 …”