Postoperative fungal discitis in immune-competent patients: A series of five patients

Abstract

Introduction: Postoperative fungal discitis is a rare phenomenon and sparse data are available concerning the cause and adequate treatment guidelines especially in immune-competent patients. This case series reports fungal spondylodiscitis in five immune-competent patients after minimal access spine surgery. Study Design: Retrospective observational study. Materials and Methods: Retrospectively five patients with postoperative fungal discitis were studied. Spine radiographs, gadolinium contrast magnetic resonance imaging, and hematological markers (erythrocyte sedimentation rate/C-reactive protein) were performed in all patients. All patients underwent posterior debridement and stabilization procedure followed by antifungal therapy at our center. The clinical outcomes in the form of Oswestry disability index (ODI) and visual analog scale (VAS) scores were recorded before index surgery, 3 months, and at final follow-up. Results: All patients, four men and one woman with an average age of 55.2 years (45–61), had primary coincidental minimal access spine surgery. The average delay from the primary surgery to onset of pain was 6.4 weeks (4–10 weeks). The average delay from the onset of symptoms, postprimary surgery to secondary surgery, at the author’s institution was 13.2 weeks (11–16 weeks). Preoperative values of ODI and VAS were significantly decreased from 78.8 and 8.2 to 14.4 and 1.4, respectively, at the final follow-up. There was one case of recurrence at adjacent level 3 months after antifungal treatment requiring a revision surgery and recommencement of antifungal treatment. Conclusion: A high index of suspicion is required for prompt diagnosis. Fungal study should be routinely included in tissues biopsied for infective etiology. Antifungal treatment of adequate duration with surgical debridement and stabilization should be the mainstay of treatment.