Postoperative fungal spondylodiscitis is rare (less than 5% of cases), affecting mostly immunocompromised individuals.

It is often because of Candida albicans or other common Candida species, whereas unusual strains such as Candida sake are often thought to be nonpathogenic.

It is often a delayed diagnosis by the indolence of symptoms, presenting itself as a serious infection, which may result in important functional consequences.

It appears that the clinical course and prognosis of postoperative fungal spondylodiscitis is similar to that reported for postoperative pyogenic spondylodiscitis ¹⁾.

Fungal spondylodiscitis after surgery represents an intractable and troublesome complication, and surgical debridement may not impede the progression of the infection in cases where an insufficient course of antifungal treatment is administered. Such cases may require prolonged antifungal treatment with regular consultation by an infectious disease specialist ²⁾.

Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests ³⁾.

A 75-year-old male, with constitutional complaints and intense back pain. Prior recent history of left hemicolectomy due to diverticulitis with multiple surgical complications, resulted in prolonged intensive care unit hospitalisation, and, later on, an episode of fungal endophthalmitis. The diagnosis of spondylodiscitis L5/S1 was performed by MRI. The patient underwent surgical disco-vertebral debridement and isolation of a Candida albicans was seen in the collected surgical material. No evidence of an immunossupressive status was found. Treatment was complemented with liposomal amphotericin B in the maximum recommended dose ⁴⁾.

see Candida albicans spondylodiscitis

In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to Candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails ⁵⁾.

A 46-year-old man presented with Aspergillus fumigatus spondylodiscitis after lumbar surgery. He was successfully treated with the new antifungal drug itraconazole in combination with surgical débridement of the disc space. The patient has remained on itraconazole for more than a year and tolerated the drug well ⁶⁾.

Actinomyces meyeri ⁷⁾.

C. lusitaniae spondylodiscitis after discography in an immunocompetent patient with long-term follow-up ⁸⁾.

A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery ⁹⁾.