Postoperative discitis after instrumentation and interbody fusion
In the Carmouche series 1) of postoperative discitis after instrumentation and interbody fusion with an epidural abscess, the patient underwent two procedures to eradicate the infection, the first was surgical debridement and epidural abscess drainage and because of the worsening clinical symptoms, underwent repeat debridement and the removal of his interbody cage and pedicle screw instrumentation four months after index surgery. At ten-month follow-up, the posterolateral arthrodesis was healed and his back pain had improved compared to preoperative levels.
Kulkarni et al. 2) reported a case of adjacent level discitis after anterior cervical discectomy and fusion. The patient underwent surgical treatment with debridement, irrigation, and removal of hardware, and reconstruction of infected level by tricortical iliac crest autograft; the cages were left intact. He had IV antibiotic treatment for three weeks and oral medication for three weeks. The neurological recovery was complete and at eight-month-follow-up the fusions were sound.