Discitis after procedures on the intervertebral disc

Abstract

Study design: Discitis after discectomy is frequently missed or detected too late because of false interpretation of postoperative complaints and examinations. Prospectively, the authors examined 31 patients after single-level discectomies. The results were compared with four clinical cases of postoperative infection.

Methods: From the first to tenth postoperative day, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and temperature were measured. On the fifth or sixth day, magnetic resonance examination was performed with and without administration of gadolinium diethylene triamine penta-acetic acid (Gd-DTPA). All patients were included in follow-up, which included radiographic and clinical examinations, for 3 years.

Results: Thirty of thirty-one patients had CRP values less than 2.5 micrograms/mL, ESR values less than 45 mm/hr, and temperatures less than or equal to 37.5 C. Magnetic resonance imaging showed normal postoperative features. Four patients with infection had increased levels of CRP, ESR, and temperature. Magnetic resonance imaging showed retrodiscal infection and spondylodiscitis.

Conclusion: After discectomies, CRP, ESR, and temperature should be measured from the third day on. Pathologic values should initiate magnetic resonance examination. In cases of retrodiscal infection or discitis, conservative treatment with antibiotics is sufficient. In cases of retrodiscal abscess, operative intervention should be considered.