Microsurgical management of postoperative disc space infection.
We analysed seventeen patients with septic postoperative spondylodiscitis (POD) who were managed by early microsurgical removal of the infected necrotic tissue, application of a closed suction-irrigation system (for a mean of 6.7 days), and early mobilisation. The POD was diagnosed clinically by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values and radiographically by computerised tomography scanning or magnetic resonance imaging. According to the sensitivity studies of the obtained pathogens, systemic antibiotics were given, followed by early mobilisation of all patients in a light cast corset. Immediate pain relief was noted in all patients except one, who required a third operation that was followed by rapid clinical improvement. Bacteriological diagnosis was obtained in 88% of the patients. Excellent or good clinical long-term results were achieved in 82% of the patients, whereas 18% had poor results. Elevated ESR/CRP values returned to normal ranges within 6 to 44 days (mean 15 days) after reoperation. All but one patient tolerated early mobilisation (within 2 to 4 weeks) well without any complication. Early microsurgical removal of the necrotic and infected tissue and application of a closed suction-irrigation system supported by specific antibiotic therapy should be considered an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient.
Bavinzski
Gerhard
G
Department of Neurosurgery, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. gerhard.bavinzski@akh-wien.ac.at
Schoeggl
Andreas
A
Trattnig
Siegfried
S
Standhardt
Harald
H
Dietrich
Wolfgang
W
Reddy
Marion
M
Al-Schameri
Rachman
R
Horaczek
Alfred
A
D000328:Adult; D000368:Aged; D015299:Discitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D013396:Suction; D013530:Surgical Wound Infection / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D007507:Therapeutic Irrigation