title: Postoperative initial single fungal discitis progressively spreading to adjacent multiple segments after lumbar discectomy.
abstract: OBJECTIVE
  To report multiple cases and investigate etiology of initially single fungal spondylodiscitis that progressively spread to adjacent segments following lumbar discectomy, resulting in multiple spinal involvements.
  
  
  METHODS
  From January 2005 to May 2013, ten adult patients were admitted or referred to our institution with postoperative discitis. Fungal infections were confirmed by microbiologic and pathologic examinations. The clinical appearance, radiographic features, and treatments of this pathology were investigated.
  
  
  RESULTS
  All the patients were previously healthy. The average interval between the occurrence of symptoms and primary lumbar discectomy was 61 days (range, 15-120 days). All the patients were treated with anterior surgical debridement, interbody fusion, and prolonged antifungal therapy. Three patients additionally received combined posterior instrumented fusion. Despite aggressive surgical debridement and antifungal therapy, spread of the infections to adjacent multiple discs was observed. No deaths, severe neurologic deficits, or deterioration of neurologic status were noted. The infections were completely resolved in all cases with spontaneous fusion within an average follow-up of 32.4 months.
  
  
  CONCLUSIONS
  Fungal spondylodiscitis after surgery represents an intractable and troublesome complication, and surgical debridement may not impede the progression of the infection in cases where an insufficient course of antifungal treatment is administered. Such cases may require prolonged antifungal treatment with regular consultation by an infectious disease specialist.
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: Ming-xiang
authors.initials: MX
authors.lastname: Zou
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: An-bo
authors.initials: AB
authors.lastname: Peng
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: Zhi-hui
authors.initials: ZH
authors.lastname: Dai
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: Xiao-bin
authors.initials: XB
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China. Electronic address: jingli1969@126.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: Guo-hua
authors.initials: GH
authors.lastname: Lv
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: You-wen
authors.initials: YW
authors.lastname: Deng
authors.affiliation: Department of Spine Surgery, The Second Xiangya Hospital of Central South University, No. 139, Middle of Renmin Road, Changsha 410011, Hunan, PR China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wang
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D015299:Discitis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Fungal infection; Postoperative spondylodiscitis; Rapid progression; Treatment