Discitis after discography. The role of prophylactic antibiotics

Abstract

Discitis after discography is due to bacterial penetration into the intervertebral disc by a contaminated needle and has an incidence of 1% to 4%. We have examined the prophylactic role of cephazolin administered at the time of discography. An experimental study in sheep using radiographic contrast containing Staphylococcus epidermidis showed that either adding the antibiotic to the intradiscal suspension or giving it intravenously 30 minutes before intradiscal inoculation of bacteria prevented any radiographic, macroscopic or histological signs of discitis; all the intervertebral disc cultures were negative. In a prospective clinical study of 127 consecutive patients having lumbar discography, the injected contrast contained cephazolin 1 mg per ml. None of the patients developed clinical or radiographic signs of discitis. We recommend the use of a suitable broad spectrum antibiotic in a single prophylactic dose whenever the intervertebral disc is entered.

In vitroassessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions

“…Dosages required depend on the bacterial strain inoculated into the disc. As recommended by Osti et al [23] and subsequently by Endres and Bogduk [24], intradiscal antibiotic dosages for discography range from 1 to 10 mg ml -1 [23,24]. Taking into account the results of our experiments, dosages for gentamicin of 1 mg ml -1 would inhibit growth of all five bacterial strains examined by over 10-fold.…”

“…The most serious complication is postinterventional bacterial discitis owing to the invasiveness of the procedure [2,4,5,16]; as such, many publications deal with prophylactic intravenous (iv) administration of antibiotics. Several animal experiments in sheep, lambs and rabbits, conducted in the 1980s, 1990s and in 2006, demonstrated antibiotics in the intervertebral discs after systemic iv injection (with higher concentrations in the annulus fibrosus than in the nucleus pulposus) [17][18][19][20][21][22][23].…”

“…However, it was emphasised that the timing of the systemic antibiotic prophylaxis was critical [17,21,23]. Conversely, post-interventional systemic administration of antibiotics was not considered beneficial [21,22].…”

“…In 1990, Osti et al [23] conducted animal experiments and, subsequently, a clinical study in 127 patients, examining 337 discs, in whom an antibiotic was added to the intradiscally administered RCM, in addition to earlier iv prophylaxis [23]. Post-interventional discitis was not detected in either the animals or the patients.…”

Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption

“…The most serious complication of discography, which is the risk of discitis, is rare [28]. Additionally, the already low incidence can be further reduced by the intradiscal use of prophylactic antibiotics [24].…”