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
Background: Spinal aspergillus infection is rare but can cause significant morbidity and mortality. Sometime it may mis-diagnosed as pyogenic or tuberculous infection in immunocompetent patients. Therefore, it causes delay in diagnosis and leads to spinal instability, neurological deficit, and sometimes death. Case Report: Here we discussed a case of 68 years old female patient with severe back pain and difficulty in walking which was gradually increased over the period of time of two months. During this, she was diagnosed as koch’s spine based on MRI report and she had been started on empirical anti-tuberculous medication. But her condition was deteriorated. After that patient underwent surgical management and infected tissue sent for culture and sensitivity and histopathological examination. The report was positive for aspergillus fungal infection. she was started with anti-fungal medication and course of treatment was uneventful. Conclusion: Early diagnosis of spinal fungal infection is often delayed in immunocompetent patients and it lead to delayed in anti-fungal management which lead to increase in morbidity and mortality. Keywords: Aspergillus, Spinal fungal infection, Case Report
Summary and Background: Spontaneous spinal epidural hematoma (SSEH) is a known occurrence in patients on anticoagulant therapy. There is an increased risk of developing hematoma after the spine surgery if anticoagulation therapy is reinstated. Purpose of Study: The purpose of the study was to find out solution related with perioperative anticoagulant therapy in high-risk cases if patient redevelops hematoma and paraplegia due to continuation of anticoagulant therapy. Case Report: A 30-year-old male presented to us with history of progressive paraparesis. He had history of mitral valve replacement twice followed by cerebrovascular stroke and on regular oral anticoagulant therapy. Magnetic resonance imaging revealed SSEH from C6-T1 level with cord compression. Initial decision was taken to conservatively treat as his coagulation parameters were altered and he was on high-risk for developing thromboembolism related complications if anticoagulant medicines were stopped. However, urgent laminectomy and evacuation of SSEH had to be performed due to rapid worsening of neurology. Postoperatively, patient had significant neurological recovery and anticoagulant therapy reinstated after 12 h of surgery. Patient developed acute paraplegia within 2 hours of anticoagulant therapy due to post-operative hematoma, which was drained out by opening the wound bedside. He regained neurological recovery within 5 min. Anticoagulation therapy was withheld for next 36 hours and reinstated with low-dose intravenous heparin followed by low-molecular weight heparin without any complications. His coagulation parameters and 2-D echo were followed up daily to check cardiac conditions. Patient improved clinically and became self-ambulatory. Conclusion: Post-operative hematoma after spine surgery should be kept in mind in patients who are on anticoagulant treatment. Reinstating anticoagulation treatment in such high-risk patients should be done with lot of caution and initially with low-dose heparin followed by regular anticoagulation therapy. Close observation on neurological status is must to avoid permanent neurological injury. Keywords: Spontaneous spinal epidural hematoma, Anticoagulat treatment, Decision dilemma
Purpose: The objective of this study is to analyze the clinical and radiological outcome of Minimally Invasive-Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in terms of estimated blood loss (EBL), operative time, length of stay (LOS) in the hospital, complication, Oswestry disability index (ODI) score, visual analog scale (VAS) score, and parameters of sagittal spinal balance before and after surgery. The parameters of sagittal spinal balance included in this study were pelvic Incidence (PI), lumbar lordosis, focal lordosis at the index level. Materials and Methods: All cases were retrospectively followed up. Single-level and double-level MIS-TLIF procedures for back pain and leg pain operated between 2015 and 2018 were included in the study. PI, Lumbar lordosis, Focal lordosis at index level was measured on preoperative, post-operative, and final follow-up lateral lumbosacral X-ray in the supine position. Demographic data, intraoperative blood loss, operative time, LOS, ODI score, and VAS score at different times were reviewed and analyzed. Results: Fifty-four patients were included among them 24 were male and 30 were female. The average age of the patients was 51.6 ± 12.1 years. Sixteen double-level surgery and 38 single-level surgeries. The average value of follow-up was found to be 39.6 ± 12.4 months. The average value of operative time, the EBL and the LOS were 170.8 ± 19.8 min, 132.1 ± 34.8 mL, and 4.8 ± 0.8 days, respectively. The average PI was 54.9 ± 11.2° preoperatively, 55.0 ± 10.7° postoperatively and 54.8 ± 10.9° at the final follow-up. Pre-operative lumbar lordosis and focal lordosis were 44.55 ± 12.9° and 7.76 ± 5.2°, respectively with postoperatively and final follow-up to 48.88 ± 13.1° and 10.62 ± 5.1°, respectively. VAS score and ODI scales were improved significantly from preoperative 8.4 ± 0.9 and 56.3 ± 4.9, respectively, to postoperatively and final follow-up 2.0 ± 0.8 and 21.6 ± 5.4, respectively. The postoperative complications and revision occurred in 8 (14.8%) and 4 (7.4%) patients, respectively. Conclusion: MIS-TLIF is a novel technique with the good radiological and clinical outcome with decreased perioperative morbidity. It is also superior to open TLIF in terms of EBL, hospital LOS, operative time, perioperative morbidity, and surgical complications. Keywords: Minimally invasive-transforaminal lumbar interbody fusion, Clinical improvement, Pelvic incidence, Lumbar lordosis, Focal lordosis
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.