Postoperative discitis. Diagnosis and management.

Postoperative discitis (POD) continues to be a diagnostic challenge and its management remains variable. This article raises the following questions and presents new observations. What is the current role of the CT scan in POD? Is a uniform pathogen involved and is there a basis for the duration of intravenous antibiotics? What is the expected long-term functional result? In a retrospective analysis of 12 consecutive patients with POD followed for an average of 29 months (17-42 months), the CT scan was extremely sensitive in showing a pathogen was present. The CT scan was misread in over one-third of the cases. Gram-positive cocci were the only organisms cultured (10 of 13 cultures, 8 of 12 patients). The erythrocyte sedimentation rate (ESR) invariably fell predictably to normal within 90 days when patients were treated with IV antibiotics for more than 40 days. Most patients were clinically improved and subjectively better at follow-up examination. No correlation existed between the patient's subjective result and preexisting medical conditions, the type of antibiotic, or the length of treatment, the ESR, or the follow-up roentgenograms.