Postlaminectomy disc space infection. A review of the literature and a report of three cases.

Postlaminectomy disc space infection is a relatively modern disease that is frequently mentioned, rarely encountered, sometimes not recognized, and unquestionably iatrogenic. A total of 125 cases have been reported since 1947. The bulk of the evidence favors a bacteriologic agent, but the route of infection is still not clear, because both hematogenous and local origins are possible in a surgically traumatized area with poor blood supply. This report of three additional cases emphasizes the variety of presentations. The diagnosis is difficult but can be made if it is suspected. Patients complain of recurrent pain after initial relief of symptoms. Muscle spasm, elevated temperature, and positive straight leg raising test are the most common signs. Increased sedimentation rate is almost always present. The roentgenographic findings appear several weeks after the initial symptoms. Radioisotope and CAT scans may be helpful earlier. Needle biopsy/aspiration under image intensification increases the frequency of bacteriologic identification. Conservative management based on bed rest, immobilization, and antibiotics remains the treatment of choice. Early surgical treatment may be indicated in some cases and seems to eradicate the disease, hastening recovery. Late surgical intervention, when indicated, is facilitated by an anterior approach.