Surgical Management of Pyogenic Discitis of Lumbar Region

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective review of patients who had pyogenic discitis and were managed surgically.
Purpose: To analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically.
Overview of Literature: Surgical management of pyogenic discitis is still an infrequently used modality of treatment.
Methods: A total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16−75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months.
Results: Debridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4−5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients.
Conclusions: Pyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report.

참고문헌 (Reference)

1 Liljenqvist U, "Titanium cages in the surgical treatment of severe vertebral osteomyelitis" 12 : 606-612, 2003

2 Nolla JM, "Spontaneous pyogenic vertebral osteomyelitis in nondrug users" 31 : 271-278, 2002

3 Yemisci OU, "Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case" 35 : E1006-E1009, 2010

4 Przybylski GJ, "Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis" 94 : 1-7, 2001

5 Lehovsky J, "Pyogenic vertebral osteomyelitis/disc infection" 13 : 59-75, 1999

6 Eysel P, "Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study" 6 : 152-157, 1997

7 Butler JS, "Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center" 31 : 2695-2700, 2006

8 Mann S, "Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients" 17 : E3-, 2004

9 Ozalay M, "Non-tuberculous thoracic and lumbar spondylodiscitis: single-stage anterior debridement and reconstruction, combined with posterior instrumentation and grafting" 76 : 100-106, 2010

10 Sapico FL, "Microbiology and antimicrobial therapy of spinal infections" 27 : 9-13, 1996

11 Modic MT, "Magnetic resonance imaging of the spine" 24 : 229-245, 1986

12 Osenbach RK, "Diagnosis and management of pyogenic vertebral osteomyelitis in adults" 33 : 266-275, 1990

13 Sobottke R, "Current diagnosis and treatment of spondylodiscitis" 105 : 181-187, 2008

14 Lee CK, "Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion" 20 : 356-361, 1995

15 Hee HT, "Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages" 15 : 149-156, 2002

16 White SH, "Back pain in a Bangladeshi worker in Iraq" 156 : 44-46, 2010

17 Jae Kwan Lim, "Anterior Interbody Grafting andInstrumentation for AdvancedSpondylodiscitis" 대한신경외과학회 43 (43): 5-10, 2008

18 Garcia-Bordes L, "An unusual case of spondylodiscitis" 35 : E167-E171, 2010