Endoscopic Evaluation of Aseptic Spondylodiscitis
Source: Spine Disorders 1996 Annual Meeting
Publisher: The Joint Section on Spine and Peripheral Nerves
Major subject: Spine and Peripheral Nerve
Publication type: Poster
Date of publication: Feb 1996
Ditsworth DA, Robson D
Four hundred sixty-four outpatient percutaneous discectomies, performed under local anesthesia by the senior author over the past 4 1/2 years, were analyzed. Three of these patients developed aseptic spondylodiscitis.
A 48-year-old morbidly obese white female with an L3-4 lumbar disc herniation reported severe lumbar pain about a month following nucleotomy with a nucleotome. Conservative treatment was given. Subsequently, plain films and MRI showed marked erosion of the vertebral endplates (spondylodiscitis). Percutaneous endoscopic visualization of the inflamed disc was then performed approximately three months postnucleotomy, with Gram stains, cultures, and biopsies. All studies were negative and the patient fully recovered without further surgery.
A 64-year-old black male had lumbar disc herniations and nucleotomies at L2-3 and L4-5 using a nucleotome and holmium laser giving 3.61 KJ at L2-3 and 4.19 KJ at L4-5. After reporting severe lumbar pain and spasm, an MRI taken 6 weeks post-op showed severe inflammation (spondylodiscitis). Gram stains, cultures, and biopsies of the inflamed disc taken during percutaneous endoscopic visualization were negative. The patient recovered fully without further surgery.
The third patient, a 33-year-old white female with lumbar disc herniations at L4-5 and L5-S1 underwent L4-5 and L5-S1 nucleotomies with a nucleotome and holmium laser giving 3.0 KJ at each level. MRI with gadolinium taken 2 1/2 months later showed signal alteration of the endplates and L5 vertebral body suggesting inflammation or edema. This patient, however, did not receive endoscopic evaluation of the disc. At an outside facility, approximately three months post-nucleotomy, she underwent two-level bilateral laminotomies and facetectomies with two-level disc excisions. The patient had spondylodiscitis. No infection was found.
In conclusion, postoperative aseptic inflammation can be safely and reliably diagnosed with endoscopic methods, guiding appropriate treatment without the inconvenience and risk of needless antibiotic therapy or major surgery.
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