Percutaneous discectomy and drainage for postoperative intervertebral discitis

Abstract

Postoperative intervertebral discitis occurs following spinal surgery. This study was done to evaluate the effect of percutaneous discectomy and drainage (PDD) for postoperative intervertebral discitis. A retrospective study of postoperative intervertebral discitis treated by PDD procedures was conducted from January 1997 to June 2006. There were 34 patients (24 males, 10 females); 10 cases of after lumbar discectomy (L3-4 in 3 patients, L4-5 in 7 patients), 21 cases of after percutaneous lumbar discectomy (L3-4 in 7 patients, L4-5 in 14 patient), 2 cases of after percutaneous cervical discectomy (C5-6 in 1 patient, C6-7 in 1 patient), and 1 case of C5-6 after percutaneous cervical nucleoplasty. All patients tolerated the procedure well and there were 31 cases had followed up. VAS scores demonstrated statistically significant improvement after PDD when compared with preoperational values (P < 0.01). Elevated CRP and ESR values returned to normal range within 3-8 weeks. CRP and ESR values demonstrated statistically significant improvement after PDD when compared with preoperative values (P < 0.01). Biopsies of the disc were performed in all patients and pus was seen in 17 patients at the pathology levels. Inflammatory cells were observed nine cases (4 cases showed infiltration of lymphocytes and plasmacytes, 5 cases showed infiltrate of polymorphonuclear leucocytes). Cultures of disc and bone tissue showed 17 cases of sterile and 14 had positive culture. Spine X-rays films showed narrowed disc space in 29 cases, and bridging osteophytes were noted in 19 patients. Destructive and sclerotic changes of vertebral bodies with narrowing of disc spaces were observed in 14 patients. The results show that PDD is a minimally invasive procedure for obtaining sufficient biopsy material for histological analysis and culture in cases of discitis, and has a good clinical outcome recommended for patients with early stage postoperative intervertebral discitis without neurologic deficit.