The Bone School

Symptoms

Period of pain relief after disc surgery

- followed by increasing back pain & occasional leg pain

Pain may be disproportionate to physical findings

Low grade fever common

SLR & femoral stretch tests elicit pain in some cases 

Bloods

Normal WCC common 

ESR & CRP elevated 

Xray / MRI

MRI with Gadolinium

Investigation of choice

- well vascularized inflammatory tissue enhances on T1

Osteomyelitis changes include

- confluent hypointensity of involved bodies on T1

- hyperintensity of involved bone and disc on T2

- loss of distinction of involved bone & disc

- abnormal disc appearance

Management

Medical management

CT guided aspirate if culture required

- appropriate antibiotics

- brace

Surgical Indications

Failure non operative management

Epidural abscess

Deformity

Options

1.  Percutaneous Discectomy and Drainage

Li et al Arch Orthop Trauma Surg 2011

- 31 patients with post-operative discitis

- half had positive cultures, other half sterile

2.  Laminectomy and Drainage