Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis

Despite the use of antibiotics, the management of postoperative discitis (POD) still presents a challenge. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO2) therapy on the duration of antibiotic treatment.

Between 1999 and 2004, 22 patients diagnosed with POD were treated with antibiotic and HBO2 therapy. There were 14 male (63.6%) and 8 female (36.3%) patients, and their mean age at the time of surgery was 45.4 years (range, 20-59 years). Diagnosis of a POD was established on the basis of clinical, laboratory, and radiographic findings. All patients were given a 4-week course of vancomycin (1g i.v. every 12 h). Additionally, patients received HBO2 (100% O2 at 2.4 ATA for 90 min) twice daily for the initial five consecutive days, and an additional treatment (100% O2 at 2.4 ATA for 90 min daily) was given for 25 days. The duration of follow-up was 24 months.

This treatment modality allowed infection control and healing for all 22 patients with 0% recurrence rate. HBO2 treatment was tolerated well.

This series represents the first reported group of POD patients treated with antibiotic and HBO2 therapy. Our preliminary results indicate that the length of time on antibiotic therapy can be shortened with the use of HBO2 as an adjunctive treatment. Erythrocyte sedimentation rates and serum C-reactive protein levels returned to the preoperative levels earlier (within 8-30 days after the initiation of treatment) and a reasonable length of immobility was obtained (mean 12.2 days). After completion of the one-month period of antibiotic and HBO2 therapy, patients were accepted disease-free regarding pain and mobility.