Postoperative spondylodiscitis
see Spondylodiscitis after lumbar microdiscectomy.
see Postoperative discitis after instrumentation and interbody fusion
Epidemiology
Incidence after lumbar discectomy 1) : 0.2–4% (realistic estimate is probably at the lower end of this range). May also occur after LP, myelogram, cervical laminectomy, lumbar sympathectomy, discography, fusions (with or without instrumentation) and other procedures. Very rare after ACDF. Risk factors include advanced age, obesity, immunosuppression, systemic infection at the time of surgery.
Outcome
Postoperative discitis outcome
Primary infection of the nucleus pulposus with secondary involvement of cartilaginous endplate and vertebral body following lumbar discectomy 2).
Postoperative discitis was first described as a clinical entity by Gieseking in 1951 3).
It is controversial whether discitis can be caused by an aseptic or infectious process and positive cultures may be obtained only in 42–73% of patients. 4) 5).
Fungal postoperative spondylodiscitis
Diagnosis
Treatment
Prophylaxis
A study concluded that different techniques used for lumbar microdiscectomy revealed that standard microsurgical technique with usage of antiseptic irrigation for the disc space and usage of separate disc instruments had lesser incidence of spondylodiscitis in comparison with standard microdiscectomy. The overall incidence of postoperative discitis remains less in our series. So far, to our knowledge, this report involves the largest number of patients studied to determine the incidence of discitis in patients undergoing lumbar microdiscectomy 6).
Antibiotics given for a long time of 4-6 months.
Outcome
The majority do well with conservative treatment. Surgical management in the form of transpedicular fixation and debridement, when required, gives excellent results 7).