DISCITIS AFTER PROCEDURES ON THE INTERVERTEBRAL DISC

Study Design. Discitis after discectomy is frequently missed or detect ed too late because of false interpretation of postoperative complaint s and examinations. Prospectively, the authors examined 31 patients af ter single-level discectomies. The results were compared with four cli nical cases of postoperative infection. Methods. From the first to ten th postoperative day, C-reactive protein (CRP), erythrocyte sedimentat ion rate (ESR), and temperature were measured. On the fifth or sixth d ay, magnetic resonance examination was performed with and without admi nistration of gadolinium diethylene triamine penta-acetic acid (Gd-DTP A). All patients were included in follow-up, which included radiograph ic and clinical examinations, for 3 years. Results. Thirty of thirty-o ne patients had CRP values less than 2.5 mug/mL, ESR values less than 45 mm/hr, and temperatures less than or equal to 37.5 C. Magnetic reso nance imaging showed normal postoperative features. Four patients with infection had increased levels of CRP, ESR, and temperature. Magnetic resonance imaging showed retrodiscal infection and spondylodiscitis. Conclusion. After discectomies, CRP, ESR, and temperature should be me asured from the third day on. Pathologic values should initiate magnet ic resonance examination. In cases of retrodiscal infection or disciti s, conservative treatment with antibiotics is sufficient. In cases of retrodiscal abscess, operative intervention should be considered.