Prophylaxis of postoperative lumbar spondylodiscitis

Zink, P; Frank, Andreas; Trappe, A.

doi:10.1007/bf01780844

Cited by 15 publications

(8 citation statements)

References 7 publications

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“…The most common symptom was back pain, found in 13 cases (93%), fever found in three cases, neurological deficit in two cases and one paraplegia. The clinical symptoms appeared at an average six weeks after the primary procedure (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). MRI showed osteomyelitis and/or discitis in all cases, complicated by paravertebral abscess in three cases and by epidural abscess in four cases.…”

Section: Postoperative Fungal Spondylodiscitismentioning

confidence: 96%

“…Malnutrition, objectively defined by a serum albumin level less than 3.5 g/dL, a total lymphocyte count less than 1,500-2,000 cells/mm 3 and a serum transferrin level of 150 μg/dL is another documented risk factor.…”

Section: Incidencementioning

confidence: 99%

“…Two causes are possible, haematogenous spread, less frequently, or direct inoculation of virulent organisms during the surgery [1,3,4]. The aim of this article was to review the clinical features, operative management, outcome in patients and most important the way to diagnose and prevent it.…”

Section: Introductionmentioning

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 Fungal Spondylodiscitismentioning

confidence: 96%

Section: Incidencementioning

confidence: 99%

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Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

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“…7,8 Some reports argue that peri-operative antibiotics can eff ectively prevent post-operative spondylodiscitis. 9,10 Prophylactic antibiotic treatment must include broad spectrum IV antibiotics with known effi cacy to Staphylococcus and other commonly found microorganisms (Staphylococcus epidermidis and β-hemolytic streptococci, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Propionibacterium acnes, and diphtheroids). 18,19,20 In our practice we used vancomycin peri-operatively and then for seven days if patient is not allergic to it.…”

Section: Discussionmentioning

confidence: 99%

Outcome of micro-lumbar discectomy and preventive measures to control discitis

Shrestha¹,

Sharma²,

Bhattachan³

et al. 2020

Nep J Neurosci

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Objective: The purpose of the present study is to describe the rate of post-operative discitis following micro-lumbar discectomy. Methods and Materials: This is a retrospective study of 203 patients who underwent micro-lumbar discectomy between March 2015 and April 2018 in our institute. Prior to surgery, patients were optimized by maintaining personal hygiene, controlling blood sugar in diabetics and withholding steroids. Standardized intra-operative measures were taken to prevent discitis. Post-operatively on day 7, patients were evaluated for symptoms like back pain, fever and wound infection. If there was any sign of infection then the patient was evaluated with a plain x-ray of lumbosacral spine, inflammatory blood markers like complete blood count, erythrocyte sedimentation rate, C-reactive protein and Magnetic Resonance Imaging of lumbosacral spine to rule out discitis. Results: There were 127 males and 76 females, the age ranging from 8 years to 80 years. MRI imaging showed 94.6% single and 5.4% multilevel disc prolapses with 4.2% high lumbar and 95.8% low lumbar disc prolapse. Indications for surgery were failed conservative treatment (44), intractable pain (102), neurological deficit (49), and cauda equina syndrome (8). None of the 203 patients developed post-operative discitis, however, some of them had nerve root injury (4), dural tear (5), wound infection (5) and pseudo-meningocele (2). Almost all patients were mobilized within 48 hours (98%) after surgery. 95% were discharged on the 7th day of surgery and 5% within two weeks. Radicular pain was relieved in 92% patients within one week, 6% within three weeks and 2% had no change. Low back pain was relieved in 80% of patients in three weeks, 15% in three months and 5% had persistent back pain. The recurrence rate was 2.5% in our series. 80% had joined their previous job after four weeks, 15% after three months and 5% had changed their job. Conclusions: Post-operative discitis can be prevented if appropriate precautions are taken like using separate dedicated neurosurgical operation theatre, prophylactic antibiotics, minimally invasive procedure and not curating the end-plates.

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“…To prevent postoperative spondylodiscitis, appropriate use of antibiotics is the most important prophylaxis. Some reports argue that perioperative antibiotics can effectively prevent postoperative spondylodiscitis (18,49). Others believe that intraoperative antibiotic prophylaxis is effective to prevent postoperative spondylodiscitis after spinal surgery.…”

Section: Preventionmentioning

confidence: 99%

Management of postoperative spondylodiscitis with and without internal fixation

Wang

Tao²,

Zhu³

et al. 2013

Turkish Neurosurgery

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Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity. Although the majority of postoperative spondylodiscitis cases can be well managed by conservative treatment, postoperative spondylodiscitis after internal fixation and those cases that are unresponsive to the conservative treatment present challenges to the surgeon. Here, a review was done to analyze the treatment of postoperative spondylodiscitis with/without internal fixation. This review article suggested that majority of postoperative spondylodiscitis without internal fixation could be cured by conservative treatment. Either posterior or anterior debridement can be used to treat postoperative spondylodiscitis without internal fixation when conservative treatment fails. In addition, minimally invasive debridement and drainage may also be an alternative treatment. In case of postoperative spondylodiscitis after internal fixation, surgical treatment was required. In the cervical spine, it can be well managed by anterior debridement, removal of internal fixation, and reconstruction of the spinal stability by using bone grafting/cage/anterior plate. Postoperative spondylodiscitis after internal fixation is successfully managed by combined anterior debridement, fusion with posterior approach and removal of pedicle screw or extension of pedicle screw beyond the lesion site, in the thoracic and lumbar spine. KeywoRds: Anterior debridement, Conservative treatment, Internal fixation, Posterior debridement, Spondylodiscitis, Surgery ÖZPostoperatif spondilodiskit nispeten nadirdir. Bu komplikasyon, artmış maliyet ve uzun süreli çalışamama ve hatta morbidite ile ilişkilidir. Postoperatif spondilodiskit olgularının çoğu konservatif tedaviyle iyi takip edilebilir ama internal fiksasyondan sonra postoperatif spondilodiskit ve konservatif tedaviye cevap vermeyenler cerrah açısından zorluk çıkarırlar. Derleme internal fiksasyon ile veya olmadan postoperatif spondilodiskit tedavisinin analizini içermektedir ve internal fiksasyonsuz postoperatif spondilodiskit olgularının çoğunda konservatif tedaviyle tam başarı sağlanabileceğini düşündürmektedir. Konservatif tedavi başarısız olduğunda internal fiksasyonsuz postoperatif spondilodiskiti tedavi etmek için posterior veya anterior debridman kullanılabilir. Ayrıca minimal invaziv debridman ve drenaj da alternatif tedavi olabilir. İnternal fiksasyon sonrasında postoperatif spondilodiskit durumunda cerrahi tedavi gereklidir. Servikal omurgada bu durum anterior debridman, internal fiksasyonun çıkarılması ve kemik greftleri/kafesi/anterior plak kullanımıyla spinal stabilite-rekonstrüksiyon yoluyla iyi bir şekilde tedavi edilebilir. İnternal fiksasyon sonrasında postoperatif spondilodiskit durumu kombine anterior debridman, posterior yaklaşımla füzyon ve torasik ve lomber omurgada pedikül vidasının lezyon bölgesinin ötesine uzatılması veya pedikül vidasının çıkarılması ile başarılı bir şekilde tedavi edilebilir.

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Prophylaxis of postoperative lumbar spondylodiscitis

Cited by 15 publications

References 7 publications

Postoperative spondilodiscitis

Postoperative spondilodiscitis

Outcome of micro-lumbar discectomy and preventive measures to control discitis

Management of postoperative spondylodiscitis with and without internal fixation

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