Tag Archive for: Lumbar discectomy

Volume 3 | Issue 2 | October 2022-March 2023 | page: 55-64 | Udit D. Patel1, Hitesh N. Modi1

DOI: https://doi.org/10.13107/bbj.2022.v03i02.042

Authors: Udit D. Patel [1], Hitesh N. Modi [1]

[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.

Address of Correspondence

Dr. Udit D. Patel
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: uditpatel27@gmail.com

Abstract

Introduction: Post-disctectomy pyogenic lumbar discitis is not common condition in contrast to postoperative wound infection but its presentation is typically non-specific, which can lead to delay in diagnosis and its treatment. In this condition, patients present with low back pain after symptoms free interval. The diagnosis can be established with symptoms, examination, laboratory studies and radiological investigations.
Purpose: The aim of this literature review is to evaluate available articles about post- discectomy lumbar spondylodiscitis. we analyse the incidence, risk factors, causative organisms, diagnosis modalities (including clinical features, blood and radiological investigations), management strategies (conservative and surgical) and prevention for postoperative lumbar spondylodiscitis in the published literature.
Material and methods: We have reviewed literature articles available on topic of post-discectomy lumbar discitis in PubMed, MEDLINE and Google scholar only in English language; and have been published from the year 2000 onwards.
Results: This incidence rate of post-operative discitis is 0.94%. The age range was 38-56 years with a mean age of 45.18±4.17 years. Mean interval between discectomy and establishment of diagnosis was 2-8 weeks. Of all the patients included 61.93% were males and 38.07% were females. The most common organism isolated is staph. aureus (including methicillin sensitive and resistant staph. aureus). Majority of patients were initially treated conservatively. The surgical treatment in patients who fail to respond to conservative management has been demonstrated. Our study showed 40.1% excellent results, 56% good result and 3.9% fair and poor result at final follow up.
Conclusion: Although the incidence of post-operative lumbar discitis is rare, it’s associated with morbidity and mortality. The true challenge of post-operative discitis is to diagnose the condition timely. Majority of patients can be treated conservatively and operative management is rarely necessary in the patients with failed conservative treatment.
Keywords:  Lumbar discectomy, Postoperative pyogenic discitis, Literature review, Treatment

References

1. Ramirez, L.F. and R. Thisted, Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery, 1989. 25(2): p. 226-30; discussion 230-1.
2. Turnbull, F., Postoperative inflammatory disease of lumbar discs. J Neurosurg, 1953. 10(5): p. 469-73.
3. Jimenez-Mejias, M.E., et al., Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis, 1999. 29(2): p. 339-45.
4. Jain, M., et al., Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review. J Neurosci Rural Pract, 2019. 10(3): p. 511-518.
5. Adam, D., T. Papacocea, I. Hornea and R. Croitoru, Postoperative spondylodiscitis. A review of 24 consecutive patients. Chirurgia (Bucur), 2014. 109(1): p. 90-4.
6. Eshra, M.A., Experience in the management of post-operative spinal infection. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2019. 55(1): p. 9.
7. Park, M.K., R.A. Myers and L. Marzella, Oxygen tensions and infections: modulation of microbial growth, activity of antimicrobial agents, and immunologic responses. Clin Infect Dis, 1992. 14(3): p. 720-40.
8. Srinivas, B., D. Sekhar, G. Penchalayya and K. Murthy, Post-operative discitis- a review of 10 patients in a tertiary care neurosurgical unit. J Dental Med Sci., 2016. 15(7): p. 1-4.
9. Chang, C.W., et al., Transforaminal Interbody Debridement and Fusion to Manage Postdiscectomy Discitis in Lumbar Spine. World Neurosurg, 2019. 121: p. e755-e760.
10. Kutlay, M., et al., Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis. Undersea Hyperb Med, 2008. 35(6): p. 427-40.
11. Kaliaperumal, C., D. Kuechler, G. Kaar, C. Marks and M. O’Sullivan, Does surgical technique affect the incidence of spondylodiscitis post-lumbar microdiscectomy? A retrospective analysis of 3063 patients. Spine (Phila Pa 1976), 2012. 38(4): p. 364-7.
12. Bavinzski, G., et al., Microsurgical management of postoperative disc space infection. Neurosurg Rev, 2003. 26(2): p. 102-7.
13. Diren, F., H. Can, M. Onal and A. Kircelli, The rate of spondylodiscitis in the patients with lumbar discectomy using single dose prophylactic antibiotics. J Academic Res in Med., 2019. 9(3).
14. Kucuk, A., et al., Surgical Strategies for Spondylodiscitis due to Lumbar Disc Surgery. Turk Neurosurg, 2017. 27(1): p. 95-98.
15. Santhanam, R. and K. Lakshmi, A Retrospective Analysis of the Management of Postoperative Discitis: A Single Institutional Experience. Asian Spine J, 2015. 9(4): p. 559-64.
16. Ahn, Y. and S.H. Lee, Postoperative spondylodiscitis following transforaminal percutaneous endoscopic lumbar discectomy: clinical characteristics and preventive strategies. Br J Neurosurg, 2012. 26(4): p. 482-6.
17. Singh, D.K., N. Singh, P.K. Das and D. Malviya, Management of Postoperative Discitis: A Review of 31 Patients. Asian J Neurosurg, 2018. 13(3): p. 703-706.
18. Shah, R., A. Garud, P. Vala and V. Sharma, Early onset postdiscectomy spinal tuberculosis: an uncommon complication. Asian J Orthopedic Research, 2019. March(7): p. 1-4.
19. Zink, P.M., A.M. Frank and A.E. Trappe, Prophylaxis of postoperative lumbar spondylodiscitis. Neurosurg Rev, 1989. 12(4): p. 297-303.
20. Weinstein, M.A., J.P. McCabe and F.P. Cammisa, Jr., Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord, 2000. 13(5): p. 422-6.
21. Chaudhary, S.B., M.J. Vives, S.K. Basra and M.F. Reiter, Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med, 2007. 30(5): p. 441-51.
22. Koutsoumbelis, S., et al., Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am, 2011. 93(17): p. 1627-33.
23. Hamdan, T.A., Postoperative disc space infection after discectomy: a report on thirty-five patients. Int Orthop, 2012. 36(2): p. 445-50.
24. Moon, M.S., et al., Pyogenic discitis following discectomy. J Orthop Surg (Hong Kong), 2012. 20(1): p. 11-7.
25. Katonis, P., M. Tzermiadianos, P. Papagelopoulos and A. Hadjipavlou, Postoperative infections of the thoracic and lumbar spine: a review of 18 cases. Clin Orthop Relat Res, 2007. 454: p. 114-9.
26. Sheha, A., Surgical management of post-discectomy spondylodiscitis with transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. Life Sci J., 2011. 8(4): p. 140-42.
27. Ahsan, K., et al., Conservative versus operative management of postoperative lumbar discitis. J Craniovertebr Junction Spine, 2020. 11(3): p. 198-209.
28. Salgotra, B., S. Attry, D. Patel and K. Sansiya, Open transforaminal lumbar interbody fusion (TLIF) for post-discectomy spondylodiscitis: Our experiece. Indian J Neuroscience, 2018. 4(3): p. 144-9.
29. Chew, F.S. and M.J. Kline, Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology, 2001. 218(1): p. 211-4.
30. Rao, P.J., et al., Histological analysis of surgical samples and a proposed scoring system for infections in intervertebral discs. J Clin Neurosci, 2016. 30: p. 115-119.
31. Zhang, T., et al., One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis. Acta Orthop Traumatol Turc, 2018. 52(4): p. 277-282.
32. Harris, A.E., C. Hennicke, K. Byers and W.C. Welch, Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature. Surg Neurol, 2005. 63(6): p. 538-41; discussion 541.
33. Van Goethem, J.W., et al., The value of MRI in the diagnosis of postoperative spondylodiscitis. Neuroradiology, 2000. 42(8): p. 580-5.
34. Meyer, B., K. Schaller, V. Rohde and W. Hassler, The C-reactive protein for detection of early infections after lumbar microdiscectomy. Acta Neurochir (Wien), 1995. 136(3-4): p. 145-50.
35. Barrey, C., et al., The follow-up of patients with postoperative infection of the spine. Eur J Orthop Surg Traumatol, 2013. 23 Suppl 1: p. S29-34.
36. Kang, B.U., S.H. Lee, Y. Ahn, W.C. Choi and Y.G. Choi, Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine, 2010. 13(2): p. 158-64.
37. Enoch, D.A., et al., Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol, 2008. 61(6): p. 750-3.
38. Yang, S.C., T.S. Fu, L.H. Chen, W.J. Chen and Y.K. Tu, Identifying pathogens of spondylodiscitis: percutaneous endoscopy or CT-guided biopsy. Clin Orthop Relat Res, 2008. 466(12): p. 3086-92.
39. Basu, S., J.D. Ghosh, F.H. Malik and A. Tikoo, Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases. Indian J Orthop, 2012. 46(4): p. 427-33.
40. Luzzati, R., et al., Diagnosis, management and outcome of clinically- suspected spinal infection. J Infect, 2009. 58(4): p. 259-65.
41. Wang, X., H. Tao, Y. Zhu, X. Lu and X. Hu, Management of Postoperative Spondylodiscitis with and without Internal Fixation. Turk Neurosurg, 2015. 25(4): p. 513-8.
42. Dall, B.E., D.E. Rowe, W.G. Odette and D.H. Batts, Postoperative discitis. Diagnosis and management. Clin Orthop Relat Res, 1987(224): p. 138-46.
43. Silber, J.S., D.G. Anderson, A.R. Vaccaro, P.A. Anderson and P. McCormick, Management of postprocedural discitis. Spine J, 2002. 2(4): p. 279-87.
44. Mann, S., M. Schutze, S. Sola and J. Piek, Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus, 2004. 17(6): p. E3.
45. McHenry, M.C., K.A. Easley and G.A. Locker, Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis, 2002. 34(10): p. 1342-50.
46. Kutlay, M., A. Colak, S. Yildiz, N. Demircan and O.N. Akin, Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery, 2008. 62 Suppl 2: p. 540-6.
47. Matsui, H., N. Hirano and Y. Sakaguchi, Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J, 1998. 7(1): p. 50-4.
48. Li, J., D. Yan, L. Duan, Z. Zhang and H. Zhu, Percutaneous discectomy and drainage for postoperative intervertebral discitis. Arch Orthop Trauma Surg, 2011. 131(2): p. 173-8.
49. Fountain, S.S., A single-stage combined surgical approach for vertebral resections. J Bone Joint Surg Am, 1979. 61(7): p. 1011-7.
50. Liljenqvist, U., et al., Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J, 2003. 12(6): p. 606-12.
51. Przybylski, G.J. and A.D. Sharan, Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg, 2001. 94(1 Suppl): p. 1-7.
52. Gerometta, A., F. Bittan and J.C. Rodriguez Olaverri, Postoperative spondilodiscitis. Int Orthop, 2012. 36(2): p. 433-8.
53. Lang, R., Y. Folman, M. Ravid, T. Bental and R. Gepstein, Penetration of ceftriaxone into the intervertebral disc. J Bone Joint Surg Am, 1994. 76(5): p. 689-91.
54. Tai, C.C., et al., Antibiotic prophylaxis in surgery of the intervertebral disc. A comparison between gentamicin and cefuroxime. J Bone Joint Surg Br, 2002. 84(7): p. 1036-9.

(Abstract Text HTML)      (Download PDF)

.