Surgical Management of Pyogenic Discitis of Lumbar Region

Abstract

Study DesignRetrospective review of patients who had pyogenic discitis and were managed surgically.PurposeTo analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically.Overview of LiteratureSurgical management of pyogenic discitis is still an infrequently used modality of treatment.MethodsA total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16-75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months.ResultsDebridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4-5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients.ConclusionsPyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report.

Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

“…In Table 4, we compare our data with recently published studies on spontaneous spondylodiscitis. 3,7,9,18,22,23,[30][31][32][33][34]36 Compared to other series, our study had a mean patient age that was younger by more than 10 years, 27% of our patients were managed conservatively, only 8.3% of the conservatively managed patients required surgery, and 30-day overall mortality was less than 5%. Our series is similar to the other series in its male predominance.…”

Posterior Titanium Screw Fixation without Debridement of Infected Tissue for the Treatment of Thoracolumbar Spontaneous Pyogenic Spondylodiscitis

“…Due to the low specificity of signs and symptoms, the detection of PSD occurs late and, when there is radicular or spinal cord compression, the infection has already reached an advanced stage [ 3 4 ]. The treatment of PSD is essentially conservative with bed rest, external spinal immobilization, and administration of antibiotics [ 1 2 3 4 5 6 7 ]. However, surgery is indicated in front of a neurologic deficit, failure of antibiotic therapy and presence of spine instability [ 1 2 3 4 5 6 7 8 9 10 ].…”

Comparing Treatment Between Identification and Non-Identification of Micro-Organisms in Pyogenic Spondylodiscitis

“…Half of the micro-organism pathogens of PS are S. aureus with the second and third most common pathogens varying between each region. In the Devkota et al 10 study, S. aureus is the most common pathogen (45.2%), E. coli (16.6%), K. pneumonia (14.2%). Where as, in the Aagaard et al, 11 study, the most common pathogen is S. aureus (58.0%) with the second-most common being the Streptococcus species (12.0%), and E. coli (4.0%).…”