Role of Surgical Stabilization in the Management of Post-discectomy Septic Spondylodiscitis: Two Successful Case...

Spondylodiscitis is an inflammation (most commonly due to infection) involving the intervertebral disc and adjacent vertebral bodies. It represents a serious spinal condition that can lead to vertebral destruction, spinal instability, neurological deficits, and significant morbidity. Although the primary treatment consists of targeted antibiotic therapy and immobilization, surgical intervention becomes necessary in cases associated with spinal instability, neurological compromise, or failure of conservative treatment. Recent studies have shown that spinal instrumentation can be safely performed in the presence of infection when combined with adequate surgical debridement and appropriate antibiotic therapy, which prevent motion at the pathological site and promote healing.

We report two cases of lumbar post-discectomy septic spondylodiscitis with spinal instability managed surgically. The first case involved a patient who developed multilevel lumbar spondylodiscitis following a previous L5-S1 microdiscectomy, presenting with persistent back pain and a discharging sinus. The second patient also had a history of L4 L5 discectomy, complicated by post-operative infection, leading to progressive neurological weakness and inability to ambulate. Both patients underwent surgical debridement, decompression, and pedicle screw stabilization. Intraoperative cultures revealed Pseudomonas aeruginosa infection in the first case and Escherichia coli in the second case, and targeted antibiotic therapy was initiated.

Both patients showed significant post-operative improvement with early ambulation, progressive neurological recovery, reduction of inflammatory markers, and satisfactory wound healing on follow-up.

Surgical stabilization combined with adequate debridement and targeted antibiotic therapy plays a crucial role in the management of septic spondylodiscitis. Instrumentation provides immediate spinal stability, promotes healing, facilitates early mobilization, and results in favorable clinical outcomes even in the presence of active infection.