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PubMed1973

[Discitis].

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Child, Preschool↗
PubMed2002

Spontaneous disc space infections in adults.

BACKGROUND: Spontaneous discitis typically affects children; much less is known about the disease in adults. We examined the clinical characteristics and the role of surgery in spontaneous infectious discitis in adults. METHODS: Twenty-nine consecutive adult patients (16 men, 13 women) with spontaneous infectious discitis were treated by a single surgeon (MJE) over a 5-year period. These patients were compared to 19 consecutive patients with postoperative discitis over the same time period. Mean follow-up was 2.4 years. RESULTS: The average age of patients with spontaneous discitis was 69.0 years. Eleven of these patients (38%) were diabetic and 9 (31%) had a known concurrent infection. Infections occurred at cervical (10%), thoracic (34%), and lumbar interspaces (59%), and at multiple disc spaces in eight cases (28%). Ten patients (34%) had an elevated serum leukocyte count and 21 patients (72%) had an elevated erythrocyte sedimentation rate. While Gram-positive infection was most common, a broad spectrum of microbes was isolated. All patients were treated with i.v. antibiotics for a mean duration of 6 weeks. Four patients required surgical fusion; the rest were treated with external immobilization. At follow-up, 21 patients (72%) were symptom-free, 3 patients (10%) had ongoing disease, and 5 patients (17%) had died of unrelated causes. Compared to patients with postoperative discitis treated over the same time period, spontaneous discitis in adults affected older patients and required a broader spectrum of antibiotic coverage. Outcomes were similar between the two groups. CONCLUSIONS: While spontaneous discitis has predominantly been reported in children, the disease also affects older adults. Spontaneous discitis in adults is associated with advanced age, diabetes mellitus, and systemic infection. Elevated serum leukocyte count lacks diagnostic sensitivity. A high cure rate is achieved with antibiotics and external immobilization. Surgical treatment is rarely required.

Aged↗
PubMed2004

Lumbar discography: should we use prophylactic antibiotics? A study of 435 consecutive discograms and a systematic review of the literature.

BACKGROUND: Lumbar discography can be used in the diagnostic work-up of degenerative spine disease. The most serious complication is discitis, believed to be due to penetration of the disc by a needle contaminated with skin flora. The use of prophylactic antibiotics has been advocated, although there is great concern regarding their efficacy and possible adverse effects on disc cells. METHODS: In the current study, the incidence of postdiscography discitis without the use of prophylactic antibiotics was studied in a consecutive patient group. Additionally, a systematic literature review was performed using strict criteria: 1). Discography was performed by means of a two-needle technique, 2). complications such as discitis were specifically looked for at follow-up, and 3). the exact numbers of patients and those lost to follow-up were reported. RESULTS: The clinical results of 200 patients with 100% follow-up for a minimum period of 3 months showed no case of discitis. In the literature review, 10 studies were selected. Nine studies without prophylactic antibiotics reported an overall incidence of 12 cases in 4891 patients (0.25%) or 12770 discs (0.094%). The only study with prophylactic antibiotics (127 patients) showed no case of discitis. CONCLUSIONS: Regarding the small number of patients in the only study in which antibiotics were used and the overall low incidence of postdiscography discitis, not enough evidence was found that prophylactic antibiotics can prevent discitis. It was concluded that in lumbar discography by means of a two-needle technique without prophylactic antibiotics, the risk of postdiscography discitis is minimal and there is not enough support from the literature to justify the routine use of prophylactic antibiotics.

Anti-Bacterial Agents↗
PubMed1998

The postoperative lumbar spine. A radiological investigation of the lumbar spine after discectomy using MR imaging and CT.

PROBLEMS AND AIMS: The clinical outcome of repeat lumbar discectomy is not as satisfactory as that of the primary surgical procedure. One reason is the difficulty of assessing post-operative radiological investigations and particularly the significance of the various radiological changes. A second problem is differentiating between the two forms of post-operative discitis, a rare but important complication after lumbar discectomy. The aims of this study were: to improve understanding of the significance of certain post-operative radiological changes; and to evaluate differences in the MR features of septic and aseptic post-operative discitis. MATERIAL AND METHODS: A total of 192 patients (209 disc levels) took part in this study; all had had prior lumbar discectomy. Nineteen of these patients were regarded as asymptomatic and they served as a control group in the evaluation of certain post-operative changes in the symptomatic patients. Twelve patients with post-operative discitis were examined in order to compare the MR features of septic and aseptic discitis. MR imaging was performed first without and then with contrast enhancement in all patients. Contrast-enhanced MR imaging was also compared with contrast-enhanced CT. RESULTS: Owing to its superiority in distinguishing the nerve roots at the surgical site, MR imaging was found to be a more valuable diagnostic method than CT. Disc herniations were found in 16% of the disc levels in asymptomatic patients and in 38% of the disc levels in the symptomatic patients. Significantly more disc herniations were found in patients who had only a short duration of recurrent symptoms (maximum 3 months) before MR investigation than in the asymptomatic patients. Nerve-root displacement due to disc herniation was also significantly more frequent in patients with the short symptom duration than in patients with a longer symptom duration. True intradural nerve-root enhancement was found in 7% of symptomatic patients, and focal enhancement in the root sleeve was found in 26% of them; there was good correlation to clinical symptoms and other pathological findings. Thickened nerve roots were found with equal frequency in asymptomatic and symptomatic patients. Epidural scar tissue diminished with time, showing no significant difference between asymptomatic and symptomatic patients. Out of 6 patients with septic post-operative discitis, 3 showed extensive MR changes; the remaining 3 showed moderate changes which were similar to those in another 6 patients who had aseptic discitis. DISCUSSION AND CONCLUSION: MR is the imaging method of choice in the evaluation of patients with recurrent clinical symptoms after disc surgery. Disc herniations may be found in asymptomatic patients; it is therefore important to assess the plausibility of the assumption that the finding of a herniated disc correlates well with the actual clinical symptoms. Nerve-root displacement and nerve-root enhancement caused by recurrent disc herniation may strengthen the indication for repeat discectomy. On the other hand, the finding of a thickened nerve root seems to be of no diagnostic value. The MR features in post-operative discitis develop only gradually and the differentiation between septic and aseptic forms of discitis is thus difficult at the early stage.

Contrast Media↗
PubMed1993

[Value of the assay of protein SAA and urinary antitrypsin activity in osteoarticular infections].

Erythrocyte sedimentation rate is normal in 20% to 25% of patients with discitis due to common pathogens. We evaluated serum amyloid A (SAA) protein and urinary trypsin inhibitory activity in osteoarticular infections comparatively with erythrocyte sedimentation rate and serum C-reactive protein in 20 patients including 14 with discitis due to common pathogens and 6 with septic arthritis. Assays were performed on D0, D8, D15, D30, and D60 after initiation of antimicrobial therapy. On D0, all four markers were significantly higher in patients with septic arthritis than in patients with discitis. C-reactive protein levels exhibited the fastest kinetics with a return to normal values within 15 days in both conditions. Urinary trypsin inhibitory activity was only slightly elevated in patients with discitis and returned to normal within 30 days in both conditions. Serum amyloid A levels required 30 to 60 days to return to normal. Erythrocyte sedimentation rate exhibited the slowest kinetics, with normal values being achieved only after 60 days. Although simple, rapid, and inexpensive, urinary trypsin inhibitory activity determination exhibits poor sensitivity. Serum amyloid A assay is not routinely available but may be a valuable parameter for monitoring patients whose erythrocyte sedimentation rate and C-reactive protein level are normal (as in 2 of our patients with discitis).

Arthritis, Infectious↗