Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature.
BACKGROUND
No previous report has described a progressive, destructive postoperative discitis requiring operative stabilization due to Propionibacterium acnes. The clinical and radiographic features and treatment options associated with discitis due to P acnes are presented in a retrospective case study, as well as a review of the current literature.


METHODS
Seven weeks after a routine lumbar discectomy, the patient presented with clinical findings and radiographic imaging consistent with discitis. Intraoperative cultures obtained from irrigation and debridement of the disc space revealed P acnes, and appropriate intravenous antibiotic treatment was instituted. Approximately 2 months later, the patient showed progression to a destructive osteomyelitis requiring operative stabilization. Nine weeks after stabilization, the patient continued to have lower back pain without radiculopathy. Laboratory values had normalized. Radiographic imaging revealed good instrumentation positioning and adequate fusion. The patient was ambulatory with bilateral articulating ankle foot orthoses and a walker.


CONCLUSIONS
The reported case adds to the literature on postoperative discitis due to P acnes and demonstrates that this organism can occasionally be the cause of progressive, destructive osteomyelitis. In addition, we review the incidence, risk factors, and clinical course of discitis due to P acnes.
Harris
Anthony E
AE
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Hennicke
Chrisanne
C
Byers
Karin
K
Welch
William C
WC
D017586:Diskectomy / Q000009:adverse effects; D020802:Epidural Abscess / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007403:Intervertebral Disc / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery; D017116:Low Back Pain / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D008160:Lumbosacral Plexus / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D011843:Radiculopathy / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013115:Spinal Canal / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome