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[Postoperative lumbar discitis. Types, diagnosis and treatment]
1Reumatologisk afdeling, Hillerød Sygehus.
Abstract:
Medical reports of 17 patients with discitis after lumbar disc operation (PD) were analyzed retrospectively. None of the patients had had previous lumbar disc operations. The diagnosis was confirmed by laminar tomography. The prevalence of PD was 2.75%. We found indications of bacterial infection in 82% of the cases. For all patients the infection was long lasting, with hospital contact for a mean period of eight months. PD was classified into three categories according to symptoms and laboratory investigations (ESR, CRP, WBC and alkaline phosphatase): type I = acute septic PD (53%), type II = subacute septic PD (29%), and type III = aseptic PD (18%). For PD type I and type II we recommend that antibiotics be administered intravenously until a fall in ESR and CRP are seen, followed by peroral antibiotics until normalisation. For all three types immobilisation of the back and analgetics are necessary.
Insights
Discitis after lumbar disc operation (PD) is a persistent infection, often bacterial, requiring prolonged treatment. Early diagnosis and tailored antibiotic therapy, alongside immobilization, are crucial for patient recovery.
Area of Science:
- Spinal surgery
- Infectious diseases
Context:
- Postoperative discitis (PD) is a rare complication following lumbar disc surgery.
- This study retrospectively analyzed 17 patients diagnosed with PD.
Purpose:
- To investigate the characteristics, prevalence, and management of discitis after lumbar disc operation.
- To classify PD based on clinical and laboratory findings and propose treatment strategies.
Summary:
- The study identified a PD prevalence of 2.75%, with bacterial infection indicated in 82% of cases.
- Patients experienced prolonged hospital stays (mean 8 months).
- PD was categorized into acute septic (Type I), subacute septic (Type II), and aseptic (Type III).
Impact:
- Findings inform diagnostic approaches and treatment protocols for postoperative discitis.
- Recommendations include intravenous antibiotics followed by oral antibiotics for septic types, and immobilization/analgesics for all types.
- Highlights the need for vigilant monitoring and management of this complication.