Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis.
METHODS
An analysis of the incidence of spondylodiscitis after lumbar disc surgery in 1642 patients. In 508 patients no prophylactic antibiotics were given. In 1134 patients a collagenous sponge containing gentamicin was placed in the cleared disc space.


OBJECTIVE
To report the incidence of postoperative spondylodiscitis in cases in which no antibiotic prophylaxis was used, and to define the value of a collagenous sponge containing gentamicin in preventing disc space infections.


BACKGROUND
Spondylodiscitis is considered to be a rare complication of lumbar disc surgery. The retrospective design of most studies and the rare use of magnetic resonance imaging for early radiologic diagnosis suggest that the reported incidence rates may be underestimates. Postoperative spondylodiscitis is the result of intraoperative contamination and, theoretically, could be prevented by treating these patients with prophylactic antibiotics.


METHODS
In 1642 patients, 1712 discectomies were performed. In 508 of these patients no prophylactic antibiotics were given; in 1134 of these patients a collagenous sponge containing gentamicin was placed in the cleared disc space. Clinical reexamination and, in cases of unsatisfactory results, laboratory and radiologic investigations were performed 4-8 weeks after surgery.


RESULTS
In nineteen of the 508 patients who were not treated with antibiotic prophylaxis (3.7%) a postoperative spondylodiscitis developed, whereas none of the 1134 patients who received antibiotic prophylaxis became symptomatic (P < 0.00001).


CONCLUSIONS
In the current study, a 3.7% incidence of postoperative spondylodiscitis was found in the absence of prophylactic antibiotics. Gentamicin-containing collagenous sponges placed in the cleared disc space were effective in preventing postoperative spondylodiscitis.
Rohde
V
V
Department of Neurosurgery, Klinikum Kalkweg, Duisburg, Germany.
Meyer
B
B
Schaller
C
C
Hassler
W E
WE
D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015299:Discitis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D017586:Diskectomy / Q000706:statistics & numerical data*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015503:Surgical Sponges
D000900:Anti-Bacterial Agents; D005839:Gentamicins