Abstract
Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14–59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.
Key words: Percutaneous discectomy, Osteomyelitis, Haematogenous spondylodiscitis, Aspiration
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References
- 1.Bircher MD, Tasker T, Crawshaw C, Mulholland RC. Discitis following lumbar surgery. Spine. 1988;13:98–102. doi: 10.1097/00007632-198801000-00023. [DOI] [PubMed] [Google Scholar]
- 2.Collert S. Osteomyelitis of the spine. Acta Orthop Scand. 1977;40:283–290. doi: 10.3109/17453677708988770. [DOI] [PubMed] [Google Scholar]
- 3.Digby JM, Kersley BJ. Pyogenic nontuberculous spinal infection. J Bone Joint Surg Br. 1979;61:47. doi: 10.1302/0301-620X.61B1.370121. [DOI] [PubMed] [Google Scholar]
- 4.Dufek P, Salis Soglio G, Bozdech Z. Die unspezifische bakterielle Spondylitis - eine Analyse von 32 Fällen. Z Orthop Ihre Grenzgeb. 1987;125:255–261. doi: 10.1055/s-2008-1044724. [DOI] [PubMed] [Google Scholar]
- 5.Friedrich M, Kramer J. Neue Aspekte in der Diagnostik der Spondylodiszitis. Z Orthop Ihre Grenzgeb. 1990;128:503–506. doi: 10.1055/s-2008-1039604. [DOI] [PubMed] [Google Scholar]
- 6.Hodgson AR, Stock FE. Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg Am. 1960;42:295. [Google Scholar]
- 7.Krödel A, Stürz H. Differenzierte operative und konservative Therapie der Spondylitis und Spondylodiszitis. Z Orthop Ihre Grenzgeb. 1989;127:587–596. doi: 10.1055/s-2008-1040296. [DOI] [PubMed] [Google Scholar]
- 8.Meurer A, Eysel P, Heine J. Ergebnisse der operatives Behandlung der Spondylitis tuberculosa. Z Orthop Ihre Grenzgeb. 1995;133:227–335. doi: 10.1055/s-2008-1039442. [DOI] [PubMed] [Google Scholar]
- 9.Otten R, Ludwig C, Rütt J. Die spezifische und unspezifische Spondylitis — eigene Nachuntersuchungsergebnisse. Orthop Praxis. 1992;28:113–115. [Google Scholar]
- 10.Peters KM, Schwanitz B, Zilkens KW. Spondylodiszitis - eine häufig spät gestellte Diagnose. Orthop Praxis. 1992;28:108–112. [Google Scholar]
- 11.Postacchini F, Cinotti G. Postoperative lumbar discitis. Eur Spine J. 1993;1:226–230. doi: 10.1007/BF00298364. [DOI] [PubMed] [Google Scholar]
- 12.Thibodeau AA. Closed space infection following removal of lumbar intervertebral disc. J Bone Joint Surg Am. 1968;50:400–410. doi: 10.2106/00004623-196850020-00019. [DOI] [PubMed] [Google Scholar]
- 13.Valls J, Ottolenghi CE, Schajowicz F. Aspiration biopsy in diagnosis of lesions of vertebral bodies. JAMA. 1984;136:375–382. doi: 10.1001/jama.1948.02890230016004. [DOI] [PubMed] [Google Scholar]
- 14.Yu WY, Siu C, Wing PC, Schweigel JF, Jetha N. Percutaneous suction aspiration for osteomyelitis. Spine. 1991;16:198–202. [PubMed] [Google Scholar]