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Postoperative spondilodiscitis

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Abstract

Introduction

Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition.

Materials and methods

A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis.

Results

We found that the principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilise the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple cultures of bone and soft tissue, perform a thorough debridement of infected tissue, decompress neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation.

Conclusions

Appropriate management requires aggressive medical treatment and, at times, surgical intervention. If recognised early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome. A review of the literature was done to advance our understanding of the diagnosis, treatment, prevention and outcome of these infections.

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References

  1. Rawlings CE, Wilkins RH, Gallis HA, Goldner JL, Francis R (1983) Postoperative intervertebral disc space infection. Neurosurgery 13:371–376

    Article  PubMed  Google Scholar 

  2. Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F (1997) Spondylodiscitis: clinical and magnetic resonance diagnosis. Spine 22:1741–1746

    Article  PubMed  CAS  Google Scholar 

  3. Zink P-M, Frank AM, Trappe AE (1989) Prophylaxis of postoperative lumbar spondylodiscitis. Neurosurg Rev 1989:297–303

    Article  Google Scholar 

  4. Fraser RD, Osti OL, Vernon-Roberts B (1987) Discitis after discography. J Bone Joint Surg Br 69:26–35

    PubMed  CAS  Google Scholar 

  5. Nielsen VH, Iversen E, Ahlgren P (1990) Postoperative discitis radiology of progress and healing. Acta Radiol 31:559–563

    PubMed  CAS  Google Scholar 

  6. Jimenez-Mejias ME, de Dios CJ, Sanchez-Lora FJ et al (1999) Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis 29:339–345

    Article  PubMed  CAS  Google Scholar 

  7. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA (1992) Morbidity and mortality in association with operations on the lumbar spine. J Bone Joint Surg Am 74:536–543

    PubMed  CAS  Google Scholar 

  8. El-Gindi S, Aref S, Salama M (1976) Infection of intervertebral discs after operation. J Bone Joint Surg Br 58:114–116

    PubMed  CAS  Google Scholar 

  9. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, McCormick P (2002) Management of postprocedural discitis. Spine J 2(4):279–287

    Article  PubMed  Google Scholar 

  10. Fang A, Hu S, Endres N, Bradford D (2005) Risk factors for infections after spinal surgery. Spine 30:1460–1465

    Article  PubMed  Google Scholar 

  11. Dufour V, Feydy A, Rillardon L et al (2005) Comparative study of postoperative and spontaneous pyogenic spondylodiscitis. Semin Arthritis Rheum 34:766–771

    Article  PubMed  Google Scholar 

  12. Sapkas GS, Mavrogenis AF, Mastrokalos DS, Papadopoulos E, Papagelopoulos EC, Papagelopoulos PJ (2006) Postoperative spine infection: a retrospective analysis of 21 patients. Eur J Orthop Surg Traumatol 16(4):322–326

    Article  Google Scholar 

  13. Friedman BC, Simon GL (1987) Candida vertebral osteomyelitis: report of three cases and a review of the literature. Diagn Microbiol Infect Dis 8:31–36

    Article  PubMed  CAS  Google Scholar 

  14. Mawk JR, Ericksson DL, Chou SN et al (1983) Aspergillus infections of the lumbar disc spaces. Report of the three cases. J Neurosurg 58:270–274

    Article  PubMed  CAS  Google Scholar 

  15. Lotfinia I, Vahedi P (2010) Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature. Eur Spine J 19(Suppl 2):S226–S232

    Article  PubMed  Google Scholar 

  16. Peters-Christodoulou MN, De Beer F, Bots G et al (1991) Treatment of postoperative Aspergillus fumigatus spondylodiskitis with itraconazole. Scand J Infect Dis 23:373–376

    Article  PubMed  CAS  Google Scholar 

  17. Parry M, Grant B, Yukna M et al (2001) Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 32:352–357

    Article  PubMed  CAS  Google Scholar 

  18. Chen F, Lü G, Kang Y et al (2006) Mucormycosis spondylodiscitis after lumbar disc puncture. Eur Spine J 15:370–376

    Article  PubMed  Google Scholar 

  19. Lenzi J, Agrillo A, Santoro A et al (2004) Postoperative spondylodiscitis from Aspergillus fumigatus in immunocompetent subjects. J Neurosurg Sci 48:81–85

    PubMed  CAS  Google Scholar 

  20. Li J, Yan D, Duan L, Zhang Z, Zhu H, Zhang Z (2011) Percutaneous discectomy and drainage for postoperative intervertebral discitis. Arch Orthop Trauma Surg 131(2):173–178

    Article  PubMed  Google Scholar 

  21. Harris AE, Hennick C, Byers K, Welch WC (2005) Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature. Surg Neurol 63(6):538–541

    Article  PubMed  Google Scholar 

  22. Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ (2011) Postoperative anterior spondylodiscitis after posterior pedicle screw instrumentation. Spine J 11(1):24–29

    Article  PubMed  Google Scholar 

  23. Carmouche JJ, Molinari RW (2004) Epidural abscess and discitis complicating instrumented posterior lumbar interbody fusion: a case report. Spine 29(23):E542–E546

    Article  PubMed  Google Scholar 

  24. Kulkarni AG, Hee HT (2006) Adjacent level discitis after anterior cervical discectomy and fusion (ACDF): a case report. Eur Spine J 15(suppl 5):S559–S563

    Article  Google Scholar 

  25. Jeon DW, Chang BS, Jeung UO, Lee SJ, Lee CK, Kim MS et al (2009) A case of postoperative tuberculous spondylitis with bizarre course. Clin Orth Surg 1:58–62

    Article  Google Scholar 

  26. Kaplan ES (1973) Post-diskectomy tuberculous abscess. J Neurosurg 38:358–361

    Article  PubMed  CAS  Google Scholar 

  27. Almeida A (2005) Tuberculosis of the spine and spinal cord. Eur J Radiol 55:193–201

    Article  PubMed  Google Scholar 

  28. Tack KJ, Rhame FS, Brown B et al (1982) Aspergillus osteomyelitis: report of four cases and review of the literature. Am J Med 73:295–300

    Article  PubMed  CAS  Google Scholar 

  29. Kim KW, Ha KY, Kim MS et al (2008) Postoperative trichosporon asahii spondylodiscitis after open lumbar discectomy: a case report. Spine 33:E116–E120

    Article  PubMed  Google Scholar 

  30. Garcia-Vidal C, Cabellos C, Ayats J, Font F, Ferran E, Fernandez-Viladrich P (2009) Fungal postoperative spondylodiscitis due to Scedosporium prolificans. Spine J 9:e1–e7

    Article  PubMed  Google Scholar 

  31. Ozuna RM, Delamarter RB (1996) Pyogenic vertebral osteomyelitis ans postsurgical disc space infections. Orthop Clin North Am 27(1):87–94

    PubMed  CAS  Google Scholar 

  32. Rohde V, Meyer B, Schaller C, Hassler WE (1998) Spondylodiscitis after lumbar discectomy. Spine 23:615–620

    Article  PubMed  CAS  Google Scholar 

  33. Bavinzski G, Schoeggl A, Trattnig S et al (2003) Microsurgical management of postoperative disc space infection. Neurosurg Rev 26:102–107

    Article  PubMed  Google Scholar 

  34. Schulitz KP, Assheuer J (1994) Discitis after procedures on the intervertebral disc. Spine 19:1172–1177

    Article  PubMed  CAS  Google Scholar 

  35. Fouquet B, Goupille P, Jattiot F et al (1992) Discitis after lumbar disc surgery. Features of « aseptic » and « septic » forms. Spine 17(3):356–358

    Article  PubMed  CAS  Google Scholar 

  36. Valls J, Ottolenghi CE, Schajowicz F (1948) Aspiration biopsy in diagnosis of lesions of vertebral bodies. J Am Med Assoc 136(6):276–382

    Article  Google Scholar 

  37. Enoch DA, Cargill JS, Laing R et al (2008) Value of CT-guided biopsy in te diagnosis of septic discitis. J Clin Pathol 61(6):750–753

    Article  PubMed  CAS  Google Scholar 

  38. Staatz G, Adam GB, Keulers P, Vorwerk D, Gunther RW (1998) Spondylodisckitis abscesses: CT-guided percutaneous catheter drainage. Radiology 208(2):363–367

    PubMed  CAS  Google Scholar 

  39. Gebhard JS, Brugman JL (1994) Percutaneous discectomy for the treatment of bacterial discitis. Spine 19(7):855–857

    Article  PubMed  CAS  Google Scholar 

  40. Haaker RG, Senkal M, Kilelich T, Kramer J (1997) Percutaneous lumbar discectomy in the treatment of lumbar discitis. Eur Spine J 6(2):98–101

    Article  PubMed  CAS  Google Scholar 

  41. Onik G (1996) Automated percutaneous biopsy in the diagnosis ans treatment of infectious discitis. Neurosurg Clin N Am 7(1):145–150

    PubMed  CAS  Google Scholar 

  42. Berk RH, Yazici M, Atabey N, Ozdamar OS, Pabuccuoglu U, Alici E (1996) Detection of Mycobacterium tuberculosis in formaldehyde solution-fixed, paraffin-embedded tissue by polymerase chain reaction in Pott’s disease. Spine 21(17):1991–1995

    Article  PubMed  CAS  Google Scholar 

  43. Nikaido T, Ishibashi K, Otani K, Yabuki S, Konno S, Mori S et al (2007) Mycobacterium bovis BCG vertebral osteomyelitis after intravesical BCG therapy, diagnosed by PCR-based genomic deletion analysis. J Clin Microbiol 45(12):4085–4087

    Article  PubMed  CAS  Google Scholar 

  44. Ribeiro MA, Barouni AS, Augusto CJ, Augusto MV, Lopes MT, Salas CE (2007) PCR identification of Mycobacterium tuberculosis complex in a clinical sample from a patient with symptoms of tuberculous spondylodiscitis. Braz J Med Biol Res 40(1):1–4

    Article  PubMed  CAS  Google Scholar 

  45. Verettas D, Kazakos C, Tilkeridis C, Dermon A, Petrou H, Galanis V (2003) Polymerase chain reaction for the detection of Mycobacterium tuberculosis in synovial fluid, tissue samples, bone marrow aspirate and peripheral blood. Acta Orthop Belg 69(5):396–339

    PubMed  Google Scholar 

  46. Khan IA, Vaccaro AR, Zlotolow DA (1999) Management of vertebral diskitis and osteomyelitis. Orthopedics 22:758–765

    PubMed  CAS  Google Scholar 

  47. Wirtz DC, Genius I, Wildberger JE, Adam G, Zilkens KW, Niethard FU (2000) Diagnostic and therapeutic management of lumbar and thoracic sompdylodiscitis—an evaluation of 59 cases. Arch Orthop trauma Surg 120(5–6):245–251

    Article  PubMed  CAS  Google Scholar 

  48. Moon MS (2006) Development in the management of tuberculosis of the spine. Curr Orthop 20(2):132–140

    Article  Google Scholar 

  49. Benli IT, Acaroglu E, Akalin S, Kis M, Duman E, Un A (2002) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234

    PubMed  Google Scholar 

  50. Kumar R (2005) Spinal tuberculosis: with reference to the children of north India. Childs Nerv Syst 21:19–26

    Article  PubMed  Google Scholar 

  51. Calvosa G, Bonicoli E, Restuccia G, Mancusi G, Po F (2004) A single-stage posterior approach in the treatment of spinal tuberculosis: case report. J Orthop Traumatol 5(3):185–187

    Article  Google Scholar 

  52. Iversen E, Nielsen VA, Hansen LG (1992) Prognosis in postoperative discitis. A retrospective study of 111 cases. Acta Orthop Scand 63(3):305–309

    Article  PubMed  CAS  Google Scholar 

  53. Luzzati R, Giacomazzi D, Danzi MC, Tacconi L, Concia E, Vento S (2009) Diagnosis, management and outcome of clinically-suspected spinal infection. J Infect 58(4):259–265

    Article  PubMed  Google Scholar 

  54. Viale P, Furlanut M, Scudeller L et al (2009) Treatment of pyogenic (non-tuberculous) spondylodiscitis with tailored high-dose lefloxacin plus rifampicin. Int J Antimicrob Agents 33(4):379–382

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Spine Services, Lenox Hill Hospital, 130 East, 77th street, 7th floor, New York, NY, 10075, USA

    Antoine Gerometta, Fabian Bittan & Juan Carlos Rodriguez Olaverri

  2. Orthopedic Surgery, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA

    Fabian Bittan

  3. Orthopedic Surgery, NYU School of Medicine, New York, NY, USA

    Juan Carlos Rodriguez Olaverri

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  1. Antoine Gerometta
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  2. Fabian Bittan
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Correspondence to Juan Carlos Rodriguez Olaverri.

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Gerometta, A., Bittan, F. & Rodriguez Olaverri, J.C. Postoperative spondilodiscitis. International Orthopaedics (SICOT) 36, 433–438 (2012). https://doi.org/10.1007/s00264-011-1442-0

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