Microsurgical management of postoperative disc space infection |
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Authors: | Email author" target="_blank">Gerhard?BavinzskiEmail author Andreas?Schoeggl Siegfried?Trattnig Harald?Standhardt Wolfgang?Dietrich Marion?Reddy Rachman?Al-Schameri Alfred?Horaczek |
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Institution: | (1) Department of Neurosurgery, University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria,;(2) Department of Radiology, University of Vienna, Vienna, Austria, |
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Abstract: | We analysed seventeen patients with septic postoperative spondylodiscitis (POD) who were managed by early microsurgical removal
of the infected necrotic tissue, application of a closed suction-irrigation system (for a mean of 6.7 days), and early mobilisation.
The POD was diagnosed clinically by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values and radiographically
by computerised tomography scanning or magnetic resonance imaging. According to the sensitivity studies of the obtained pathogens,
systemic antibiotics were given, followed by early mobilisation of all patients in a light cast corset. Immediate pain relief
was noted in all patients except one, who required a third operation that was followed by rapid clinical improvement. Bacteriological
diagnosis was obtained in 88% of the patients. Excellent or good clinical long-term results were achieved in 82% of the patients,
whereas 18% had poor results. Elevated ESR/CRP values returned to normal ranges within 6 to 44 days (mean 15 days) after reoperation.
All but one patient tolerated early mobilisation (within 2 to 4 weeks) well without any complication. Early microsurgical
removal of the necrotic and infected tissue and application of a closed suction-irrigation system supported by specific antibiotic
therapy should be considered an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation
for the patient. |
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Keywords: | C-reactive protein Erythrocyte sedimentation rate Postoperative spondylodiscitis |
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