Intervertebral Disc Infection after Lumbar Chemonucleolysis: Report of a Case

Neurosurgery ◽  
1986 ◽  
Vol 18 (5) ◽  
pp. 616-621 ◽  
Author(s):  
Evan H. Zeiger ◽  
Edward J. Zampella
Keyword(s):  
Intervertebral Disc ◽  
Spinal Pain ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Differential Cell Count ◽  
Paravertebral Muscle ◽  
Space Infection ◽  
Objective Evidence ◽  
Differential Cell ◽  
Bone Scans

Abstract Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.

Intervertebral Disc Space Infection in a Child Presenting as a Psoas Abscess

Neurosurgery ◽  
1980 ◽  
Vol 7 (4) ◽  
pp. 395-397 ◽  
Author(s):  
Peter O. Holliday ◽  
Courtland H. Davis ◽  
Louis deS. Shaffner
Keyword(s):  
Intervertebral Disc ◽  
Psoas Abscess ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Space Infection

Postoperative intervertebral disc space infection

Neurosurgery ◽  
1983 ◽  
Vol 13 (4) ◽  
pp. 371???6 ◽  
Author(s):  
C E Rawlings ◽  
R H Wilkins ◽  
H A Gallis ◽  
J L Goldner ◽  
R Francis
Keyword(s):  
Intervertebral Disc ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Space Infection

Infection of the Intervertebral Disc Space after Placement of a Percutaneous Lumboperitoneal Shunt for Benign Intracranial Hypertension

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 1005-1009 ◽  
Author(s):  
Jose M. Cabezudo ◽  
Javier Olabe ◽  
Fernando Bacci
Keyword(s):  
Intervertebral Disc ◽  
Intracranial Hypertension ◽  
Benign Intracranial Hypertension ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Space Infection ◽  
Lumboperitoneal Shunt

Abstract The authors report the case of 22-year-old woman who developed a disc space infection after percutaneous placement of a lumboperitoneal shunt for benign intracranial hypertension.

Postoperative Intervertebral Disc Space Infection

Neurosurgery ◽  
1983 ◽  
Vol 13 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Charles E. Rawlings ◽  
Robert H. Wilkins ◽  
Harry A. Gallis ◽  
Leonard J. Goldner ◽  
Robert Francis
Keyword(s):  
Intervertebral Disc ◽  
Sedimentation Rate ◽  
Early Stage ◽  
Spinal Mobility ◽  
Intravenous Route ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Radiographic Findings ◽  
Space Infection ◽  
Bacteriological Diagnosis

Abstract Intervertebral disc space infection is an uncommon, but serious, complication of disc surgery. By a retrospective chart review, we identified 27 patients at our institution who had a postoperative disc space infection; 14 were diagnosed and treated within the last 5 years. The characteristic symptoms were severe spinal pain and limited spinal mobility beginning 7 to 30 days postoperatively. The key physical findings were paravertebral muscle spasm and marked mechanical signs. The key laboratory findings were an elevated erythrocyte sedimentation rate and a mildly elevated white blood cell count. The diagnosis was based on the clinical presentation and early radiographic changes in the vertebral bodies adjacent to the involved disc, especially irregularities of the cortical margins seen best by tomography. Definitive bacteriological diagnosis by Craig needle biopsy was attempted in 14 patients; 7 had positive cultures and all yielded a Staphylococcus species. The usual treatment consisted of the administration of antistaphylococcal antibiotics and immobilization of the spine with a spica cast, a plastic body jacket, or complete bedrest. The final radiographic findings showed bony fusion or bridging in 19 patients, and 25 patients had a pain-free recovery after 1 to 9 months. There was 1 recurrent infection, and 3 patients eventually required an anterior discectomy and fusion. Based on a review of our own cases and those reported in the literature, we stress the importance of spinal tomography in establishing the diagnosis of postoperative disc space infection at a relatively early stage in a patient who is suspected of having this condition on the basis of typical symptoms and signs combined with an elevated sedimentation rate. We recommend treatment with both immobilization of the spine and the administration of appropriate antibiotics, first by the intravenous route and then orally.

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