Postprocedural discitis of the vertebral spine: challenges in diagnosis, treatment and prevention

Summary Background Although post-procedural discitis is relatively uncommon, the consequences can be very clinically significant. Aim We reviewed aspects on the diagnosis, management and prevention of post-procedural discitis. Methods We reviewed the literature published in English over the last twenty years using a variety of appropriate search terms. Results Clinical features, microbiology results, imaging and inflammatory makers should be used in diagnosis. Every effort should be made to confirm infection to avoid unnecessary antibiotics and to facilitate targeted therapy. Surgical debridement or source control is a crucial aspect of treatment and can provide diagnosis specimens to guide antibiotic treatment. When culture results are positive, antibiotic treatment should be based on the results of antibiotic susceptibilities. There are no definitive guidelines on antibiotic therapy. A combination of agents, such as a quinolone or clindamycin, with fusidic acid or rifampicin, is indicated for empirical therapy. Early intravenous to oral switch and a minimum of six weeks of antibiotic treatment is recommended. Prevention involves antimicrobial prophylaxis perioperatively, good surgical technique and minimally invasive surgery where possible. Conclusion Much of the information currently available is sub-optimal with the absence of good clinical trials. Further research is required on alternative approaches to routine culture and on the potential role of local antibiotics as prevention measures.