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Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review
Background Postoperative discitis (POD) remains a dreaded complication in the present era of asepsis. The treatment has been traditionally conservative, but the safety of spinal implants in infective settings has prompted the surgeons to provide rigid immobilization for promoting healing. A major...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Thieme Medical and Scientific Publishers
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779550/ https://www.ncbi.nlm.nih.gov/pubmed/31595125 http://dx.doi.org/10.1055/s-0039-1697887 |
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author | Jain, Mantu Sahu, Rabi Narayan Gantaguru, Amrit Das, Sudhanshu Sekhar Tripathy, Sujit Kumar Pattnaik, Ashish |
author_facet | Jain, Mantu Sahu, Rabi Narayan Gantaguru, Amrit Das, Sudhanshu Sekhar Tripathy, Sujit Kumar Pattnaik, Ashish |
author_sort | Jain, Mantu |
collection | PubMed |
description | Background Postoperative discitis (POD) remains a dreaded complication in the present era of asepsis. The treatment has been traditionally conservative, but the safety of spinal implants in infective settings has prompted the surgeons to provide rigid immobilization for promoting healing. A major concern in a country like ours is huge patient inflow and long waiting list added to the woe of patient's refusal for a second operative intervention after a first undesirable outcome. Objectives The aim of the study was to evaluate the functional and radiological outcome of conservative management of POD and determine the methods of prevention. Settings and Design A retrospective case study series in a tertiary-level hospital. Materials and Methods Between January 2015 and 2017, 12 cases of POD (10 own and 2 referred) were managed and followed up clinically, radiologically, and with laboratory investigation. Two cases were managed surgically—one with kyphotic deformity and the other with discharging pus. Rest were managed conservatively with analgesics and intravenously followed by oral antibiotics. At 1-year follow-up, patient satisfaction was evaluated using the MacNab outcome assessment. Statistical Analysis The descriptive data were analyzed mainly by descriptive statistics using mean, median, standard deviation, and interquartile range. Results Mean follow-up in our series was 15.2 months. Except for two operated cases, we did not go for the invasive procedure for isolation of organism in any of our cases. The total duration of antibiotic in our series was for the mean of 7.3 weeks. Visual analog scale score returned from8 initially to baseline and at final follow-up—4 excellent, 6 good, and 2 had fair outcome. There was no adverse outcome. Conclusions The majority of POD can be managed conservatively. Surgery is reserved only for special cases. Magnetic resonance imaging is the investigation of choice for diagnosing discitis. Intraoperative use of gentamicin-mixed normal saline wash reduces the incidence of discitis. |
format | Online Article Text |
id | pubmed-6779550 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Thieme Medical and Scientific Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-67795502019-10-08 Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review Jain, Mantu Sahu, Rabi Narayan Gantaguru, Amrit Das, Sudhanshu Sekhar Tripathy, Sujit Kumar Pattnaik, Ashish J Neurosci Rural Pract Background Postoperative discitis (POD) remains a dreaded complication in the present era of asepsis. The treatment has been traditionally conservative, but the safety of spinal implants in infective settings has prompted the surgeons to provide rigid immobilization for promoting healing. A major concern in a country like ours is huge patient inflow and long waiting list added to the woe of patient's refusal for a second operative intervention after a first undesirable outcome. Objectives The aim of the study was to evaluate the functional and radiological outcome of conservative management of POD and determine the methods of prevention. Settings and Design A retrospective case study series in a tertiary-level hospital. Materials and Methods Between January 2015 and 2017, 12 cases of POD (10 own and 2 referred) were managed and followed up clinically, radiologically, and with laboratory investigation. Two cases were managed surgically—one with kyphotic deformity and the other with discharging pus. Rest were managed conservatively with analgesics and intravenously followed by oral antibiotics. At 1-year follow-up, patient satisfaction was evaluated using the MacNab outcome assessment. Statistical Analysis The descriptive data were analyzed mainly by descriptive statistics using mean, median, standard deviation, and interquartile range. Results Mean follow-up in our series was 15.2 months. Except for two operated cases, we did not go for the invasive procedure for isolation of organism in any of our cases. The total duration of antibiotic in our series was for the mean of 7.3 weeks. Visual analog scale score returned from8 initially to baseline and at final follow-up—4 excellent, 6 good, and 2 had fair outcome. There was no adverse outcome. Conclusions The majority of POD can be managed conservatively. Surgery is reserved only for special cases. Magnetic resonance imaging is the investigation of choice for diagnosing discitis. Intraoperative use of gentamicin-mixed normal saline wash reduces the incidence of discitis. Thieme Medical and Scientific Publishers 2019-07 2019-10-07 /pmc/articles/PMC6779550/ /pubmed/31595125 http://dx.doi.org/10.1055/s-0039-1697887 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Jain, Mantu Sahu, Rabi Narayan Gantaguru, Amrit Das, Sudhanshu Sekhar Tripathy, Sujit Kumar Pattnaik, Ashish Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title | Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title_full | Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title_fullStr | Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title_full_unstemmed | Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title_short | Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review |
title_sort | postoperative lumbar pyogenic spondylodiscitis: an institutional review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779550/ https://www.ncbi.nlm.nih.gov/pubmed/31595125 http://dx.doi.org/10.1055/s-0039-1697887 |
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