THE POTENTIAL CAUSATIVE FACTORS IN DISCITIS AFTER LUMBAR MACRODISCECTOMY

Yıl 2003, Cilt: 16 Sayı: 2, 79 - 84, 03.12.2016

Serdar Özgen Deniz Konya Selçuk Peker Necmettin Pamir

Öz

Objective: Development of discitis after lumbar discectomy is one of the most important complications of disc surgery. This retrospective study investigated the influence of potential contributing factors in 9 cases of postoperative discitis occurring in 2901 patients who underwent macrodiscectomy.
Methods: The specific factors considered were age, sex, history of diabetes mellitus, level of the herniated disc, number of levels operated, occurrence of dural tear and cerebrospinal fluid fistula during surgery, postoperative superficial wound infection, and antibiotic regime. Concerning the latter, Group 1 (n=471) received triple-drug multi-dose antibiotic prophylaxis, and Group 2 (n=2430) received single-drug singledose antibiotic prophylaxis.
Results: The overall incidence of postoperative discitis in the series was 0.31%. Five of the discitis patients were in Group 1 and four were in Group 2, thus the group rates of postoperative discitis were 1.06% and 0.16%, respectively. The frequencies of discitis according to level of disc herniation were 0.91% for L3-L4, 0.36% for L4-L5, and 0.33% for 15- SI. There was no correlation between postoperative discitis and post-surgery superficial wound infection.
Conclusion: The study showed that
administering a single prophylactic dose of one antibiotic prior to surgery reduces the risk of postoperative lumbar discitis and superficial wound infection. Of the factors investigated, antibiotic regimen was the only one that was significantly associated with postoperative discitis.
Key Words: Lumbar disc herniation,
discectomy, discitis

Kaynakça

• Ozgen S, rtaderi S, Elmaci I, Ozek MM, Pamir MPI. Lumbar disc herniations: Outcome analysis of 1473 operated patients. Hcuro- Orthopedics 1999;27:43-53.
• Ramirez LF, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals, neurosurgery 1989; 25: 226-230.
• Andrews DW, Lavyne Mil. Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 1990; 15:329-335.
• Blankstein A, Rubinstein E, Ezra E, Lokiec F, Caspi I, Horoszowski li. Disc space infection and vertebral osteomyelitis as a complication of percutaneous lateral discectomy. Clin Orthop 1987;225:234-237.
• Ford LT, Rey JA. Postoperative infection of intervertebral disc space. South Med J 1955; 78:1295-1303.
• Fraser RD, Osti OL, Vernon-Roberts B. Discitis following chemonucleolysis. An experimental study. Spine 1986; 11:679-687.
• Leung PC. Complications in the first 40 cases of microdiscectomy. J Spinal Disord 1988; I : 306-310.
• El-Gindi S, Aref S, Salama M, Andrew J. Infection of intervertebral discs after operation. J Bone Joint Surg Br 1976:58:114- 116.
• Fernand R, Lee CK. Postlaminectomy disc space infection. A review of the literature and a report of three cases. Clin Orthop 1986; 209:215-218.
• Lind holm TS, Pylkkanen P. Discitis following removal of intervertebral disc. Spine I982;7: 618-622.
• Lowell TD, Errico TJ, Eskenazi MS. Use of epidural steroids after discectomy may predispose to infection. Spine 2000; 15:516- 619.
• Pilgaard S. Discitis (closed space infection) following removal of lumbar intervertebral disc. J Bone Joint Surg Am 1969;51:713-716.
• Puranen J, Makela J, Lahde S. Postoperative intervertebral discitis. Arch Orthop Scand 1984;55:461-465.
• Rawlings CE, Wilkins Rtf Gallis flA, Goldner JL, Francis R. Postoperative intervertebral disc space infection, neurosurgery 1983;3:371- 376.