Post operative spondylodiscitis, stabilization and fusion

ABSTRACT

Tweleve patients with postoperative spondylodiscitis [POD] not responding to conservative treatment, were managed by early surgical debridment of the infected necrotic tissue, transpedicular fixation and fusion and early mobilisation. Their mean age was 41.4 years old [range 28-65], 7 males and 5 females. Diagnosis was achieved 2 weeks to 3 months after disc surgery. The POD was diagnosed clinically, Laboratory by elevated erythrocyte sedimentation rate [ESR] values and radiologically by 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 spinal corset. All patients experienced immediately reduced back pain and leg pain allowing them to leave their bed and start mobilisation during the first postoperative day. After a mean follow-up of 9 months [range 6-24 months] only one case was using analgesics. None had deteriorated, and all were ambulatory without bladder or bowel disturbances. Bacteriological diagnosis was obtained in 75% of the patients. Elevated ESR values returned to normal ranges within 30 to 60 days [mean 45 days] after reoperation. Early surgical removal of the necrotic and infected tissues and transpedicular stabilization of the affected spinal segment supported by specific antibiotic therapy should be considered as an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient