Postoperative disc space infection after discectomy: A report on thirty-five patients

Hamdan, Thamer A

doi:10.1007/s00264-011-1430-4

Cited by 23 publications

(30 citation statements)

References 18 publications

(18 reference statements)

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“…Internal fixation was also not required. Within nine months follow-up, all patients recovered fully without disability or neurological deficit (20).…”

Section: Surgical Treatment For Postoperative Spondylodiscitis Withoumentioning

confidence: 97%

“…For postoperative spondylodiscitis without internal fixation, operative management has been recommended when conservative treatment has failed (1,20). Posterior debridement and fusion with/without instrumentation is widely used for spontaneous infectious spondylodiscitis (12, 17, 22, 48) since most spinal surgeons are familiar with the posterior operative approach.…”

Section: Surgical Treatment For Postoperative Spondylodiscitis Withoumentioning

confidence: 99%

“…Most cases of postoperative spondylodiscitis are characterized by recurrent severe back pain and low fever after the initial spinal surgery (16,32,39). An elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level is often demonstrated (20). Both of them are useful for early diagnosis of postoperative spondylodiscitis.…”

Section: Introductionmentioning

confidence: 99%

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Management of postoperative spondylodiscitis with and without internal fixation

Wang

Tao²,

Zhu³

et al. 2013

Turkish Neurosurgery

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Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity. Although the majority of postoperative spondylodiscitis cases can be well managed by conservative treatment, postoperative spondylodiscitis after internal fixation and those cases that are unresponsive to the conservative treatment present challenges to the surgeon. Here, a review was done to analyze the treatment of postoperative spondylodiscitis with/without internal fixation. This review article suggested that majority of postoperative spondylodiscitis without internal fixation could be cured by conservative treatment. Either posterior or anterior debridement can be used to treat postoperative spondylodiscitis without internal fixation when conservative treatment fails. In addition, minimally invasive debridement and drainage may also be an alternative treatment. In case of postoperative spondylodiscitis after internal fixation, surgical treatment was required. In the cervical spine, it can be well managed by anterior debridement, removal of internal fixation, and reconstruction of the spinal stability by using bone grafting/cage/anterior plate. Postoperative spondylodiscitis after internal fixation is successfully managed by combined anterior debridement, fusion with posterior approach and removal of pedicle screw or extension of pedicle screw beyond the lesion site, in the thoracic and lumbar spine. KeywoRds: Anterior debridement, Conservative treatment, Internal fixation, Posterior debridement, Spondylodiscitis, Surgery ÖZPostoperatif spondilodiskit nispeten nadirdir. Bu komplikasyon, artmış maliyet ve uzun süreli çalışamama ve hatta morbidite ile ilişkilidir. Postoperatif spondilodiskit olgularının çoğu konservatif tedaviyle iyi takip edilebilir ama internal fiksasyondan sonra postoperatif spondilodiskit ve konservatif tedaviye cevap vermeyenler cerrah açısından zorluk çıkarırlar. Derleme internal fiksasyon ile veya olmadan postoperatif spondilodiskit tedavisinin analizini içermektedir ve internal fiksasyonsuz postoperatif spondilodiskit olgularının çoğunda konservatif tedaviyle tam başarı sağlanabileceğini düşündürmektedir. Konservatif tedavi başarısız olduğunda internal fiksasyonsuz postoperatif spondilodiskiti tedavi etmek için posterior veya anterior debridman kullanılabilir. Ayrıca minimal invaziv debridman ve drenaj da alternatif tedavi olabilir. İnternal fiksasyon sonrasında postoperatif spondilodiskit durumunda cerrahi tedavi gereklidir. Servikal omurgada bu durum anterior debridman, internal fiksasyonun çıkarılması ve kemik greftleri/kafesi/anterior plak kullanımıyla spinal stabilite-rekonstrüksiyon yoluyla iyi bir şekilde tedavi edilebilir. İnternal fiksasyon sonrasında postoperatif spondilodiskit durumu kombine anterior debridman, posterior yaklaşımla füzyon ve torasik ve lomber omurgada pedikül vidasının lezyon bölgesinin ötesine uzatılması veya pedikül vidasının çıkarılması ile başarılı bir şekilde tedavi edilebilir.

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“…Internal fixation was also not required. Within nine months follow-up, all patients recovered fully without disability or neurological deficit (20).…”

Section: Surgical Treatment For Postoperative Spondylodiscitis Withoumentioning

confidence: 97%

Section: Surgical Treatment For Postoperative Spondylodiscitis Withoumentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of postoperative spondylodiscitis with and without internal fixation

Wang

Tao²,

Zhu³

et al. 2013

Turkish Neurosurgery

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“…Meredith et al [29] describe in their review the different risk factors and modes of presentation. Hamdan [30] analyses a series of 35 cases of disc-space infections, their clinical presentation and treatment results. Quaile, and Gerometta et al [31,32] present review articles about infections associated with spinal implants.…”

mentioning

confidence: 99%

Infections of the spine are still a great problem

Stern

Serrano

2012

International Orthopaedics (SICOT)

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“…End plate injury, the cauterization of many small vessels, the presence of hematoma in the surgical area and necrotic areas due to surgery create an ideal environment for the bacteria to settle down and proliferate (10).…”

mentioning

confidence: 99%

Surgical strategies in spondylodiscitis due to lumbar disc surgery

Küçük

Karademir²,

Tümtürk³

et al. 2015

Turkish Neurosurgery

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Whereas advanced age, immunosuppression, spinal trauma, chronic renal failure and diabetes mellitus are the individual risk factors that cannot be changed in infection pathogenesis, obesity, smoking, invasive catheters and prolonged hospital stay are among the factors that can be changed. Exposure of the surgical area to the radiation, malignancy and chemotherapy also increase the postoperative infection risk (9). █ INTRODUCTION T he complication rates of spinal surgery have increased in recent years together with the increase in spinal surgery (15). The number of postoperative spondylodiscitis cases has also increased due to the increase both in surgery for the aged population and in the number of immunosuppressed cases (4,6).AIm: Despite different surgical treatment protocols at different centers for spondylodiscitis due to lumbar surgery, there is no consensus on its surgical indications. In this study, we aimed to clarify the steps to be followed in the management and treatment of postoperative spondylodiscitis. mATERIAl and mEThODS:The data of 20 cases with postoperative spondylodiscitis were evaluated. C-reactive protein (CRP) was used for diagnosis and follow-up. According to culture results of the infected material obtained from the operated cases, appropriate antibiotic treatment was initiated. In non-operated cases, parenteral empirical antibiotic treatment was implemented. Surgical treatment was planned for cases with clinical and radiological instability, abscess on imaging and those who were nonrespondent to empirical antibiotic treatment. For the cases that clinically recovered and had normal CRP levels, oral antibiotic treatment was continued after parenteral antibiotic treatment. RESUlTS:Of the cases; 13 were male (65%) and 7 were femals (35%). The mean age was 56.3 years (32-74). The most prevalent complaints in referral were waist and leg pain. Except one, all cases had increased CRP levels. All patients had spondylodiscitis on magnetic resonance imaging. Seven had radiological and clinical instability and 3 had epidural abscess. The most commonly growing microorganism in culture was Staphylococcus aureus. Surgical treatment was applied to seven cases and medical treatment to 13 cases. CONClUSION:In cases with waist pain in the postoperative period, the first potential diagnosis to be considered is spondylodiscitis. Surgical treatment should be implemented for cases resistant to empirical antibiotic treatment, with abscess on imaging, or with lumbar instability.

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Postoperative disc space infection after discectomy: A report on thirty-five patients

Abstract: Re-exploration is recommended if no response is achieved after four day's conservative treatment for or if the patient's condition is critical.

Cited by 23 publications

References 18 publications

Management of postoperative spondylodiscitis with and without internal fixation

Management of postoperative spondylodiscitis with and without internal fixation

Infections of the spine are still a great problem

Surgical strategies in spondylodiscitis due to lumbar disc surgery

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