Management of postprocedural discitis.
BACKGROUND
Fortunately, the incidence of postprocedural discitis is relatively uncommon. The paucity of physical examination findings behooves the spine care practitioner to have a high index of suspicion in any patient presenting with increasing back pain after an invasive spinal procedure. The diagnosis can often be established in a timely fashion based on the history, physical examination, laboratory studies (erythrocyte sedimentation rate, C-reactive protein and blood cultures) and imaging studies (plain radiographs, magnetic resonance imaging, computed tomography and radionuclide scanning).


OBJECTIVE
To review the English literature on the subject of postprocedural discitis. The incidence, pathophysiology, laboratory markers and imaging findings are discussed. Recommendations on treatment strategies are presented along with long-term clinical outcomes of this postprocedure complication.


METHODS
A contemporary English literature search of MEDLINE and PubMed on the topic of postoperative discitis was performed.


RESULTS
The incidence of postprocedural discitis is approximately 0.2%. The most common etiologic agent is Staphylococcus aureus. The C-reactive protein is the most sensitive clinical laboratory marker to assess the presence of infection and effectiveness of treatment response. Magnetic resonance imaging is the imaging modality of choice in the diagnosis of spinal infection. The majority of patients are managed adequately with organism-specific antibiotics and spinal immobilization with good long-term outcomes. Operative intervention (open biopsy followed by antibiotic treatment and spinal immobilization or debridement and reconstruction) in patients who fail to respond to nonoperative treatment or in the presence of neurologic worsening has been demonstrated.


CONCLUSIONS
Postprocedural discitis is a rare complication after any invasive spinal procedure. It is imperative for the treating surgeon to maintain a high index of suspicion. Appropriate laboratory and imaging studies are invaluable in establishing a timely diagnosis. In the majority of patients, antibiotic treatment along with spinal immobilization has been shown to produce good long-term outcomes. Operative intervention is rarely necessary in patients failing conservative treatment.
Long Island Jewish Medical Center, Suite 250, New Hyde Park, NY 11040, USA.
Jeff S
JS
Silber
D Greg
DG
Anderson
Alexander R
AR
Vaccaro
Paul A
PA
Anderson
Paul
P
McCormick
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D015299:Discitis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications; D013203:Staphylococcal Infections / Q000150:complications
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein