Postoperative Discitis Research Articles

Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm.

Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.

Management of Postoperative Discitis with Debridement and Novel Technique of Local Antibiotic Instillation: Functional Outcomes from a Resource-Limited Setting

Patients in low- and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting. This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008-2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imaging-confirmed discitis. After non-response or deterioration following intravenous antibiotics, patients underwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year. Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean ± SD) decreased from 9.25 ± 0.75 preoperatively to 0.67 ± 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.01-9.15, P < 0.001). JOA scores (mean ± SD) improved from 4.5 ± 2.94 to 26.42 ± 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57-23.26, P < 0.001). Kirkaldy-Willis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up. In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.

Surgical Stabilization for Post-Operative Discitis Patients Concerning Pain Relief and Functional Outcomes

OBJECTIVES This study evaluated pain relief and functional outcomes in patients who underwent surgical stabilization following post-operative discitis. METHODOLOGY A cross-sectional was conducted at the Department of Orthopedic and Spine Surgery, Peshawar. The study duration spanned from 2020-2023. The inclusion criteria for participants involved patients who had experienced post-operative discitis and subsequently underwent surgical stabilization, with a stipulated minimum follow-up period of two weeks. Pain relief was measured using the Visual Analogue Score (VAS) for back and leg pain, while functional outcomes were evaluated using the Oswestry Disability Index (ODI). The acquired data were subjected to analysis utilizing SPSS version 26.0. RESULTSOut of the 35, 51.4% were male, and 48.6% were female, with a mean age of 47.5 years (SD ± 10.9 years). The most frequently affected lumbar spine level was L4-L5 in 57.1% of patients. 31.4% were smokers, and 45.7% had comorbidities, primarily consisting of diabetes or hypertension. Significant improvements were observed for back pain (baseline: 9.29 ± 0.71, post-stabilization: 5.37 ± 1.47, p = 0.001) and leg pain (baseline: 3.32 ± 2.17, post-stabilization: 1.91 ± 1.02, p = 0.001). Functional outcomes also showed substantial recovery (baseline: 51.57 ± 6.91, post-stabilization: 34.89 ± 6.85, p = 0.001). Preoperatively, the patients exhibited a spectrum of disability levels, with 29% experiencing severe disability. After two weeks of surgical intervention, substantial improvement was noted, 6% had severe disability. At the last follow-up, only 1% remained severely disabled, underlining the significant enhancement in functional outcomes post-stabilization. CONCLUSION Surgical stabilization is associated with significant pain relief and improved functional outcomes in patients with post-operative discitis.

Management of Postoperative Discitis Following Lumber Discectomy

Background: There is no established protocol for the treatment of postoperative lumbar discitis. There are still so many controversies regarding the treatment of postoperative discitis.&#x0D; Materials and Methods: A total of 23 cases of postoperative discitis were treated from July 01, 2018 to June 30, 2021 for a period of 3 years. Initially all the patients were treated conservatively with complete bed rest, antibiotic therapy and analgesics. Most of the patients were improved clinically but who did not respond to conservative treatment for at least 4 weeks were treated surgically.&#x0D; Results Out of 23 patients, 11 (48%) patients showed significant clinical improvement after 4 weeks of starting treatment. 12 patients who failed to improve by conservative treatment were selected for surgical treatment. Among them in 5 (22%) patients only surgical debridement were done and in remaining 7 (30%) patients surgical debridement and posterior fixation were done. Most of the patients were improved by conservative treatment and among two groups of surgical treatment the fixation group showed early clinical improvement.&#x0D; Conclusions Early diagnosis and appropriate management is the key for effective treatment of postoperative discitis. Conservative management leads to an excellent result in majority of cases. Surgical intervention with or without posterior fusion is helpful when conservative treatment fails.&#x0D; Bang. J Neurosurgery 2022; 12(1): 6-11

Incidence of discitis in endoscopic spine surgery

Aim of the study was to retrospectively evaluate the incidence of discitis amongst patients undergoing endoscopic spine surgery. Material and Methods: A total of 116 patients were included in the study which underwent endoscopic discectomy. Patients were followed up in postoperative period for any backpain. They were evaluated clinically and were subjected to laboratory and radiological investigations to establish the diagnosis of postoperative discitis. Patients were given IV antibiotics initially for 4 weeks and those not responding to treatment were treated by surgical intervention. All the patients were followed up clinically, by laboratory investigations and MRI. RESULTS: Out of 116,two patients suffered from postoperative discitis. One of them responded to medical management whereas the other one required surgical debridement. CONCLUSION: Discitis following endoscopic discectomy is although a rare complication .But whenever encountered should be treated aggressively with appropriate IV antibiotics and if needed surgical intervention should be resorted to as well.

Role of intra-discal Vancomycin instillation in prevention post-operative discitis

BackgroundPost discectomy discitis is regarded as the most disabling cause of failed back surgery. Value of local intra-operative application of antibiotics in prevention of such complication has been a matter of debate. We evaluate the role of intraoperative intra-discal vancomycin powder instillation as a prophylaxis in prevention of postoperative discitis in patients undergoing microscopic discectomy. We allocated 100 patients undergoing discectomy equally into two groups. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted.ResultsThe postoperative discitis was reported in 6 cases; of them, two patients were in the Vancomycin group (4%), while four patients were in the non-Vancomycin group (8%).ConclusionsWe concluded that the intra-operative prophylaxis, with intra-discal Vancomycin, decreased the incidence of postoperative discitis but without significant statistical difference. We advocate using local vancomycin especially in high risk patients for prevention of post discectomy discitis.

Management of postoperative discitis with debridement and local antibiotic infusion: functional outcomes from a low-middle-income country

Management of postoperative discitis with debridement and local antibiotic infusion: functional outcomes from a low-middle-income country

Post-Discectomy Pyogenic Lumbar Discitis: A Literature Review

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

Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy.

Study design:Prospective comparative cohort study.Objectives:The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy.Methods:Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year.Results:Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009).Conclusions:Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

Management of post-operative discitis following discectomy in a tertiary-level hospital.

To perform retrospective analysis of 75 post-operative disc space infections after open lumbar discectomy (OLD) and to assess the outcome of their medical and surgical management in a tertiary-level hospital. Records of 50 men and 25 women aged 26-65 (mean, 42.53) years who underwent treatment for post-operative discitis (POD) after single level OLD at L3-4 (n = 8), L4-5 (n = 42), L5-S1 (n = 25) level. The POD was diagnosed according to specific clinical signs, laboratory and radiographic investigations and all of them received initial intravenous antibiotics (IVA) for at least 4-6 weeks followed by oral ones. Successful responders (n = 55) were considered in Group-C and remainder [Group-S (n = 20)] were operated at least after 4 weeks of failure. Demographic data, clinical variables, hospital stay, duration of antibiotic treatment and post-treatment complications were collected from the hospital record and assessment before and after treatment were done by using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score. Comprehensive outcome was evaluated by modified criteria of Kirkaldy-Willis. The mean follows up was 36.38 months. Significant improvement of mean VAS and JOA score was achieved in both conservative (76.36% satisfactory) and operative (90% satisfactory) groups although the difference was statistically insignificant. Although insignificant, early surgical intervention provided better results (e.g. functional outcomes, length of hospital stay and duration of antibiotic treatment therapy) than conventional conservative treatment in post-operative discitis.

Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy.

Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3months following laparoscopic sacrocolpopexy. Two surgical interventions of a case with narrated video footage is presented. Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.

Outcome of micro-lumbar discectomy and preventive measures to control discitis

Objective: The purpose of the present study is to describe the rate of post-operative discitis following micro-lumbar discectomy.&#x0D; Methods and Materials: This is a retrospective study of 203 patients who underwent micro-lumbar discectomy between March 2015 and April 2018 in our institute. Prior to surgery, patients were optimized by maintaining personal hygiene, controlling blood sugar in diabetics and withholding steroids. Standardized intra-operative measures were taken to prevent discitis. Post-operatively on day 7, patients were evaluated for symptoms like back pain, fever and wound infection. If there was any sign of infection then the patient was evaluated with a plain x-ray of lumbosacral spine, inflammatory blood markers like complete blood count, erythrocyte sedimentation rate, C-reactive protein and Magnetic Resonance Imaging of lumbosacral spine to rule out discitis.&#x0D; Results: There were 127 males and 76 females, the age ranging from 8 years to 80 years. MRI imaging showed 94.6% single and 5.4% multilevel disc prolapses with 4.2% high lumbar and 95.8% low lumbar disc prolapse. Indications for surgery were failed conservative treatment (44), intractable pain (102), neurological deficit (49), and cauda equina syndrome (8). None of the 203 patients developed post-operative discitis, however, some of them had nerve root injury (4), dural tear (5), wound infection (5) and pseudo-meningocele (2). Almost all patients were mobilized within 48 hours (98%) after surgery. 95% were discharged on the 7th day of surgery and 5% within two weeks. Radicular pain was relieved in 92% patients within one week, 6% within three weeks and 2% had no change. Low back pain was relieved in 80% of patients in three weeks, 15% in three months and 5% had persistent back pain. The recurrence rate was 2.5% in our series. 80% had joined their previous job after four weeks, 15% after three months and 5% had changed their job.&#x0D; Conclusions: Post-operative discitis can be prevented if appropriate precautions are taken like using separate dedicated neurosurgical operation theatre, prophylactic antibiotics, minimally invasive procedure and not curating the end-plates.

The effect of intradiscal vancomycin powder in the prevention of postoperative discitis: RCT study

BackgroundPost discectomy discitis, although relatively uncommon (4%), is regarded as the most disabling cause of failed back surgery. We aimed to show the effect of intradiscal Vancomycin powder in reducing or preventing postoperative discitis in patients undergoing open or microscopic discectomy. Materials and methodsThis is a prospective, randomized, comparative, multicentric study of 390 patients in which microscopic tubular disectomy was planned, either due to the failure of conservative treatment or due to the presence of a neurological deficit at the time of presentation. The patients were divided randomly into two groups. Group (A) included 192 cases, while group (B) included 198 cases. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted. The follow up was done by a third team, which did not know the patients’ grouping, so double blindness was applied. The follow up was done clinically, weekly for the first two weeks, then at the sixth week, and a three-month visit. In the case of any clinical findings suspicious of discitis during follow up, a laboratory and Contrast MRI study were requested. Outcome measuresWe aimed to assess the effectiveness of intradiscal Vancomycin in discectomy operation, with attention to postoperative complications (discitis), by measuring CRP, ESR, WBC, blood culture, and contrast MRI in the postoperative period. Social habits (smoking & drinking alcohol) and past medical history (Diabetes Mellitus) have been taken into consideration. ResultThe postoperative discitis was reported in 13 cases; of them, two patients were in the Vancomycin group (1.4%), while 11 patients were in the non-Vancomycin group (5.56%). Among the infected patients, L4-5 was the most common level (69.23%). ConclusionWe concluded that the intra-operative prophylaxis, with intradiscal Vancomycin, is effective in decreasing the incidence of postoperative discitis.

Conservative versus operative management of postoperative lumbar discitis.

Background:Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis.Aim:The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy.Methods:We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis.Results:VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t-test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up.Conclusions:Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.

Functional outcome of fenestration discectomy in discogenic lumbar canal stenosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Annual incidence of significant disc herniation causing sciatica ranges from 14% to 15%. Inspite of various treatment modalities available, fenestration discectomy still remain treatment of choice for discogenic lumbar canal stenosis. The objective of our study is to assess functional outcome and complications associated with fenestration discectomy in patients of discogenic lumbar canal stenosis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Thirty two patients who had unilateral radicular pain with clinicoradiologically confirmed posterolateral disc herniation and who failed to respond to conservative management were treated surgically by fenestration discectomy. Outcome was assessed using Oswestry disability index at 6 months follow up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Patients with neurological deficits underwent fenestration discectomy with complete relief of radicular pain in 17 patients and mild reduction in 5 patients on follow up. 23 patients had recovery from motor symptoms and 25 patients had recovery from sensory symptoms whereas 9 patients still had motor weakness and 7 patients still had sensory deficit. Oswestry disability index (ODI) score used for functional outcome at 6 months postoperatively showed 63% of the patients were having 0 to 20 ODI score with minimal disability, 34% of the patients had score of 21 to 40% with moderate disability, and 3% were having 41 to 60% ODI score with severe disability. One patient had dural tear and two patients had post-operative discitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fenestration discectomy is an excellent surgical option for discogenic lumbar canal stenosis. Fenestration discectomy is an easy, economical and effective means of treating lumbar disc prolapse with minimal acceptable complications.&lt;/p&gt;

Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review.

Background Postoperative discitis (POD) remains a dreaded complication in the present era of asepsis. The treatment has been traditionally conservative, but the safety of spinal implants in infective settings has prompted the surgeons to provide rigid immobilization for promoting healing. A major concern in a country like ours is huge patient inflow and long waiting list added to the woe of patient's refusal for a second operative intervention after a first undesirable outcome. Objectives The aim of the study was to evaluate the functional and radiological outcome of conservative management of POD and determine the methods of prevention. Settings and Design A retrospective case study series in a tertiary-level hospital. Materials and Methods Between January 2015 and 2017, 12 cases of POD (10 own and 2 referred) were managed and followed up clinically, radiologically, and with laboratory investigation. Two cases were managed surgically—one with kyphotic deformity and the other with discharging pus. Rest were managed conservatively with analgesics and intravenously followed by oral antibiotics. At 1-year follow-up, patient satisfaction was evaluated using the MacNab outcome assessment. Statistical Analysis The descriptive data were analyzed mainly by descriptive statistics using mean, median, standard deviation, and interquartile range. Results Mean follow-up in our series was 15.2 months. Except for two operated cases, we did not go for the invasive procedure for isolation of organism in any of our cases. The total duration of antibiotic in our series was for the mean of 7.3 weeks. Visual analog scale score returned from8 initially to baseline and at final follow-up—4 excellent, 6 good, and 2 had fair outcome. There was no adverse outcome. Conclusions The majority of POD can be managed conservatively. Surgery is reserved only for special cases. Magnetic resonance imaging is the investigation of choice for diagnosing discitis. Intraoperative use of gentamicin-mixed normal saline wash reduces the incidence of discitis.

Percutaneous endoscopic spinal surgery for lumbar disc prolapse in Erbil city of Iraq: A study on 60 patients

Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported. Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-operative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD. Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% . Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications.

Transforaminal Interbody Debridement and Fusion to Manage Postdiscectomy Discitis in Lumbar Spine

Traditionally, nonoperative management with long-term antibiotics and bed rest has been recommended as first-line treatment for most patients with postoperative discitis. A recent trend in treatment under a limited range of indications has been to perform surgical débridement followed by long-term administration of antibiotics. This descriptive study investigated whether transforaminal lumbar interbody débridement and fusion (TLIDF) combined with intravenous antibiotics is appropriate to manage postdiscectomy discitis. This study retrospectively analyzed demographic data, laboratory data, and radiography and magnetic resonance imaging of 10 patients with postoperative discitis who underwent surgical TLIDF followed by antibiotic treatment. Preoperative and postoperative spine sagittal alignment, visual analog scale scores, and Kirkaldy-Willis criteria for functional outcomes were evaluated. An infection clearance rate of 100% was ultimately achieved for the patients who underwent TLIDF with short posterior instrumentation. TLIDF yielded better outcomes than traditional conservative treatment in terms of spine alignment correction, functional outcomes, and quality of life. Based on previously reported data and the findings of this study, we suggest that surgical intervention should be used in certain cases, as it can achieve better outcomes than conservative treatment. We recommend a novel single posterior approach with TLIDF and posterior pedicle screw instrumentation for management of postdiscectomy discitis.

Management of Postoperative Discitis: A Review of 31 Patients.

Background:The aim of the study was to retrospectively evaluate the outcome of medical management of postoperative discitis (POD).Materials and Methods:A total of 31 patients treated for POD were included in the study. Clinical, radiological, and laboratory data of all patients were collected and evaluated. All patients were treated initially with bed rest and antibiotic therapy after radiological diagnosis. Surgical management was undertaken after failure of 4 weeks of conservative management. All cases were followed clinically with laboratory and radiological investigations.Results:Five cases failed to respond to medical management and were treated surgically with debridement and transpedicular fixation. All patients showed clinical recovery till the last follow-up.Conclusion:Early diagnosis and proper management are the keys to successful outcome of postoperative spndylodiscitis. Surgical debridement and fusion are required when conservative treatment fails.

Effectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy

The bi-needle technique is a new technique for percutaneous endoscopic lumbar discectomy. This technique combines the advantages of Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques. The aim of this study was to evaluate effectiveness of the bi-needle technique for percutaneous endoscopic lumbar discectomy and compare it with the TESSYS technique. We reviewed 86 patients with single-level lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in our hospital from June 2013 to December 2015. Bi-needle technique was used in 49 patients (30 men, 19 women; average age 40.4 ± 5.2 years). TESSYS technique was used in 37 patients (19 men, 18 women; average age 42.8 ± 6.4 years). Clinical results were evaluated and compared between the 2 groups. Symptoms in both groups were significantly improved at the last follow-up (P < 0.01). There was no statistical difference in visual analog scale and lumbar Japanese Orthopaedic Association scores between bi-needle and TESSYS groups at last follow-up (P= 0.69 and P= 0.33, respectively). Operative time was shorter in the bi-needle group (P < 0.01). Recurrence rate and reoperation rate were lower in the bi-needle group (P= 0.04 and P= 0.03, respectively). Discitis was diagnosed in 2 patients in the TESSYS group. There were no patients with postoperative discitis in the bi-needle group. The bi-needle technique is safe and effective for treatment of lumbar disc herniation. Compared with TESSYS technique, operative time is shorter, and recurrence and reoperation rates are lower.