[Infectious damage to the intervertebral disk--before and following discotomy]

Area of Science:

• Spine surgery
• Infectious diseases
• Radiology

Background:

• Postoperative complications and diagnostic errors frequently cause poor outcomes after lumbar discotomy for herniated discs.
• Degenerative changes and septic lesions of the intervertebral disc are often confused, leading to misdiagnosis.
• Pyogenic hematogenous osteomyelitis of the spine can be mistaken for degenerative disc disease or postoperative discitis.

Purpose of the Study:

• To highlight the confusion between spinal osteomyelitis and degenerative disc disease.
• To emphasize the importance of accurate preoperative diagnosis in lumbar disc surgery.
• To analyze the incidence and consequences of misdiagnosed vertebral osteomyelitis.

Main Methods:

• Retrospective review of 97 verified patients with vertebral osteomyelitis.
• Analysis of diagnostic errors and treatment outcomes.
• Comparison of clinical signs and imaging findings of osteomyelitis versus degenerative disc disease.

Main Results:

• Only 9 of 97 patients had true postoperative infection; 14 had missed or misinterpreted hematogenous osteomyelitis.
• Misdiagnoses were not revised perioperatively in any patient.
• Common confusion is attributed to similar symptoms, lumbar spine predilection, and challenges in early X-ray assessment.

Conclusions:

• Misdiagnosis of spinal osteomyelitis as degenerative disc disease is a significant issue after lumbar discotomy.
• Accurate differentiation between these conditions is essential for appropriate patient management.
• Further research into early diagnostic methods for spinal osteomyelitis is warranted.