- See: Osteomyelitis of the Spine:
- 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;
- 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
- 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;
- 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;
- 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.
Postoperative discitis. Diagnosis and management.