Postoperative discitis

SymptomsT45 discitis

 

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

 

Discitis XrayDiscitis MRI

 

MRI with Gadolinium

 

Investigation of choice

- well vascularized inflammatory tissue enhances on T1

 

MRI Gadolinium Post Operative Discitis T1MRI Gadolinium Post Operative Discitis T2

 

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

 

Post Op Discitis with 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