Infectious damage to the intervertebral disk--before and following discotomy

Bad results after discotomy for treatment of herniated lumbar disc are caused either by postoperative complications or by preoperative diagnostic errors. Very often other degenerative changes of the "Bewegungssegment" are involved and misunderstood. But also septic lesions of the intervertebral disc following pyogenic hematogenous osteomyelitis of the spine are confused with degenerative lesions. They are even treated operatively as a ruptured intervertebral disc. When pyogenic osteomyelitis may no longer by overlooked after discotomy due to her progression, she is misinterpreted as discitis following removal of intervertebral disc. Only 9 of 97 verified patients with vertebral osteomyelitis suffered from true postoperative infection of the intervertebral space after removal of a herniated disc. In 14 patients the signs of hematogenous osteomyelitis of the spine have been missed or have been explained by degenerative changes of the spine. In none of the patients the wrong diagnosis was perioperatively revised. The common confusion of osteomyelitis and degenerative disc changes can be explained by several reasons: the predilection of lumbar spine and the similarity of local signs of both diseases, the unknown or underestimated frequence of radicular lesions in osteomyelitis of the spine and the difficulties to assess osteomyelitis in early stages by X-ray examination and the frequency of accessory degenerative changes. It may be supposed that many of the reported disc space inflammations after diagnostic or therapeutic means have not been caused by these manipulations but have given occasion for them.(ABSTRACT TRUNCATED AT 250 WORDS)