- See:
Osteomyelitis of the Spine:
- Discussion:
- acute infections usually occur between 1-2 wks after surgery;
- pt who has recently undergone excision of a herniated disc and who
presents with localized back pain and spasm following a relatively
pain free interval should be suspected;
- when infection has involved disc space in the postoperative setting,
40% spontaneous fusion can be expected at 2 year follow up;
- Labs:
-
sed rate in osteomyelitis of the spine:
- following surgical diskectomy, peak elevation of the sed rate occurs around day 4, and levels
should return to normal by 2 weeks postoperatively;
- Bone Scan:
- bone scan will show increased uptake in the operative site due to
normal healing process after an operation;
-
gallium scan is more likely to accurately indicate the extent of infection;
- MRI:
-
gadolinium enhacement of adjacent vertebral bone marrow,
as well as enhancement of the disk space and posterior annulus fibrosis;
- decreased T1 disk uptake and increase disk uptake on T2 images;
- Treatment:
- depends on
level of infection;
-
if infection does not extend deep to fascia, vigorous irrigation, debridment,
& closed suction drainage are performed;
- when infection extends beneath fascia, debride down to level of
definitive surgical infection;
- bone graft is allowed to remain in place if it is not grossly contamitated;
- metal implants are usually left in place;
- early removal of the instrumentation would increase risk of pseudoarthrosis;
- wound may be left open and packed if needed;;
- patient can then undergo a delayed primary closure after subsequent
irrigation and debridment is performed;
Postoperative diskitis: distinguishing early MR imaging findings from
normal postoperative disk space changes.
Postlaminectomy disc space infection. A review of the literature and a report of three cases.
R Gernand.
CORR. Vol 209. 1986. p 215-218.
Postoperative discitis. Diagnosis and management.
Lumbar Spine Imaging: Role in Clinical Decesion Making
Scott D. Boden MD and Sam W. Wiesel MD
J Am Acad Orthop Surg: 1996; 4: 238-248.
