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Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 2, pp 173–178 | Cite as

Percutaneous discectomy and drainage for postoperative intervertebral discitis

  • Jian Li
  • Denglu YanEmail author
  • Lijun Duan
  • Zhi Zhang
  • Haodong Zhu
  • Zaihen Zhang
Orthopaedic Surgery

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Intervertebral Diskitis Treatment Percutaneous Discectomy 

References

  1. 1.
    Bavinzski G, Schoeggl A, Trattnig S et al (2003) Microsurgical management of postoperative disc space infection. Neurosurg Rev 26(2):102–107CrossRefPubMedGoogle Scholar
  2. 2.
    Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S (2008) Clinical and MRI findings of Brucellar spondylodiscitis. Eur J Radiol 67(1):153–158CrossRefPubMedGoogle Scholar
  3. 3.
    Connor PM, Darden BV (1993) Cervical discography complications and clinical efficacy. Spine 18(14):2035–2038CrossRefPubMedGoogle Scholar
  4. 4.
    Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine 29(3):326–332 discussion 332CrossRefPubMedGoogle Scholar
  5. 5.
    Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14(3):284–291PubMedGoogle Scholar
  6. 6.
    Enoch DA, Cargill JS, Laing R, Herbert S, Corrah TW, Brown NM (2008) Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol 61(6):750–753CrossRefPubMedGoogle Scholar
  7. 7.
    Fouquet B, Goupille P, Jattiot F et al (1992) Discitis after lumbar disc surgery. Features of “aseptic” and “septic” forms. Spine 17(3):356–358CrossRefPubMedGoogle Scholar
  8. 8.
    Gebhard JS, Brugman JL (1994) Percutaneous discectomy for the treatment of bacterial discitis. Spine 19(7):855–857CrossRefPubMedGoogle Scholar
  9. 9.
    Haaker RG, Senkal M, Kielich T, Kramer J (1997) Percutaneous lumbar discectomy in the treatment of lumbar discitis. Eur Spine J 6(2):98–101CrossRefPubMedGoogle Scholar
  10. 10.
    Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25(13):1668–1679CrossRefPubMedGoogle Scholar
  11. 11.
    Heyde CE, Boehm H, El Saghir H, Tschoke SK, Kayser R (2006) Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up. Eur Spine J 15(9):1380–1387CrossRefPubMedGoogle Scholar
  12. 12.
    Iversen E, Nielsen VA, Hansen LG (1992) Prognosis in postoperative discitis. A retrospective study of 111 cases. Acta Orthop Scand 63(3):305–309CrossRefPubMedGoogle Scholar
  13. 13.
    Kasperczyk A, Freyschmidt J (1994) Pustulotic arthroosteitis: spectrum of bone lesions with palmoplantar pustulosis. Radiology 191(1):207–211PubMedGoogle Scholar
  14. 14.
    Krodel A, Sturz H, Siebert CH (1991) Indications for and results of operative treatment of spondylitis and spondylodiscitis. Arch Orthop Trauma Surg 110(2):78–82CrossRefPubMedGoogle Scholar
  15. 15.
    Li J, Yan DL, Zhang ZH (2008) Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation. Eur Spine J 17(12):1664–1669CrossRefPubMedGoogle Scholar
  16. 16.
    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):259–265CrossRefPubMedGoogle Scholar
  17. 17.
    Macnab I (1971) Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 53(5):891–903PubMedGoogle Scholar
  18. 18.
    Nielsen VA, Iversen E, Ahlgren P (1990) Postoperative discitis. Radiology of progress and healing. Acta Radiol 31(6):559–563PubMedGoogle Scholar
  19. 19.
    Onik G (1996) Automated percutaneous biopsy in the diagnosis and treatment of infectious discitis. Neurosurg Clin N Am 7(1):145–150PubMedGoogle Scholar
  20. 20.
    Ozuna RM, Delamarter RB (1996) Pyogenic vertebral osteomyelitis and postsurgical disc space infections. Orthop Clin North Am 27(1):87–94PubMedGoogle Scholar
  21. 21.
    Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA (2004) Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 80(948):607–609CrossRefPubMedGoogle Scholar
  22. 22.
    Sharma SK, Jones JO, Zeballos PP, Irwin SA, Martin TW (2009) The prevention of discitis during discography. Spine 9(11):936–943CrossRefGoogle Scholar
  23. 23.
    Staatz G, Adam GB, Keulers P, Vorwerk D, Gunther RW (1998) Spondylodiskitic abscesses: CT-guided percutaneous catheter drainage. Radiology 208(2):363–367PubMedGoogle Scholar
  24. 24.
    Tronnier V, Schneider R, Kunz U, Albert F, Oldenkott P (1992) Postoperative spondylodiscitis: results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation. Acta Neurochir (Wien) 117(3–4):149–152CrossRefGoogle Scholar
  25. 25.
    Valls J, Ottolenghi CE, Schajowicz F (1948) Aspiration biopsy in diagnosis of lesions of vertebral bodies. J Am Med Assoc 136(6):376–382PubMedGoogle Scholar
  26. 26.
    Viale P, Furlanut M, Scudeller L et al (2009) Treatment of pyogenic (non-tuberculous) spondylodiscitis with tailored high-dose levofloxacin plus rifampicin. Int J Antimicrob Agents 33(4):379–382CrossRefPubMedGoogle Scholar
  27. 27.
    Wirtz DC, Genius I, Wildberger JE, Adam G, Zilkens KW, Niethard FU (2000) Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis—an evaluation of 59 cases. Arch Orthop Trauma Surg 120(5–6):245–251CrossRefPubMedGoogle Scholar
  28. 28.
    Zeidman SM, Thompson K, Ducker TB (1995) Complications of cervical discography: analysis of 4400 diagnostic disc injections. Neurosurgery 37(3):414–417CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Jian Li
    • 1
  • Denglu Yan
    • 1
    Email author
  • Lijun Duan
    • 2
  • Zhi Zhang
    • 1
  • Haodong Zhu
    • 1
  • Zaihen Zhang
    • 1
  1. 1.Orthopedic DepartmentThird Hospital of Guangzhou Medical CollegeGuangzhouPeople’s Republic of China
  2. 2.West China Second University HospitalSichuan UniversityChengduPeople’s Republic of China

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