Systematic review of the incidence of discitis after cervical discography

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21205, USA.
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 02/2010; 10(8):739-45. DOI: 10.1016/j.spinee.2009.12.022
Source: PubMed


Cervical discography is not uniformly used in part because of the fear of discitis. Studies report widely varying rates of this life-threatening infection.
The aim of this study was to estimate the incidence of discitis after cervical discography, delineate the consequences of discitis, and identify factors that may influence this complication.
Studies pertaining to cervical discography were identified by a literature review and bibliographic search. These were screened for inclusion into the meta-analysis by two reviewers. Data were collected on a wide range of clinical and demographic variables including age, gender, morbidities, number of patients, number of discograms, use of prophylactic antibiotics, type of surgical prep, number of needles used, and the number of patients and discs infected. Primary data were used to calculate the incidence of discitis per patient and per disc.
Fourteen studies were included in the analysis. Both procedural details and demographic information on patients were missing from eight studies. The mean age of patients ranged from 41 to 47 years, and gender distribution varied greatly. Antibiotics use was reported in three studies. Cervical discography was complicated by postprocedural discitis in 22 of 14,133 disc injections (0.15%) and 21 of 4,804 patients (0.44%). Only one patient suffered from an infection at more than one spinal level.
The rate of discitis after cervical discography is relatively low. This can perhaps be further decreased by the use of prophylactic intradiscal antibiotics. Should the ability of cervical discography to improve surgical outcomes be proven, the fear of discitis should not preclude performance of disc provocation.

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    • "Discitis or epidural abscess after discogram is a rare but known complication. The incidence of discitis after discography has been reported to be 1% to 4%, which led to the use of the double-needle technique and prophylactic antibiotics during discography [1] [2] [3] [4] [5] [6] [7] [8]. Spondylodiscitis after low back procedures is more commonly bacterial; however, fungal discitis because of Candida and Aspergillus has also been reported. "
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    ABSTRACT: Discitis or epidural abscess after discogram is a rare but known complication. It is more commonly bacterial; however, fungal discitis has been previously reported in immunocompromised patients. The management of fungal discitis in immunocompetent patients is rarely presented or addressed in the literature. To present a rare atypical fungal discitis after routine discogram with a typical presentation in an immunocompetent host, review diagnostic and management guidelines for discitis, and provide recommendations for management of atypical discitis in immunocompetent patients. Case report and review of the literature. A 40-year-old woman presented with a 3-week history of progressively worsening low back pain after a lumbar discogram. Magnetic resonance imaging revealed L3-L4 discitis without an epidural abscess. Left L3 and L4 hemilaminectomies with L3-L4 discectomy were performed. An inflammatory mass was seen in the L3-L4 disc space region extending to the left L3 foramen. Culture specimens obtained during surgery from both the disc and epidural space speciated to Candida lusitaniae. The patient completed a 6-month course of fluconazole therapy. At 2-year follow-up, she continued to be asymptomatic, without any recurrence of infection or neurologic sequelae. We report a case of C. lusitaniae spondylodiscitis after discography in an immunocompetent patient with long-term follow-up. Clinicians must maintain a high index of suspicion for discitis in patients who undergo this procedure. If discitis is suspected, culture specimens must be evaluated for fungal and mycobacterial organisms, even in the immunocompetent host. With proper surveillance, surgical intervention, and appropriate postoperative follow-up, this complication can be effectively managed with excellent long-term outcome.
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    ABSTRACT: COMMENTARY ON: Kapoor SG, Huff J, Cohen SP. Systematic review of the incidence of discitis after cervical discography.
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