Postoperative Lumbar Spondylodiscitis Following Transforaminal Endoscopy and Outcomes of Transforaminal Lumbar Interbody Fusion

Abstract

Objective: To describe the presentation spectrum of postoperative spondylodiscitis (POS e ) following transforaminal endoscopic lumbar discectomy and to report the outcomes of transfo-raminal lumbar interbody fusion (TLIF). Methods: This study analyzed all patients with the classic features of POS e who underwent index surgery elsewhere and presented to us. They had not responded to conservative care for 3 weeks and were operated further with open TLIF. The treatment response was judged by the declining values of inflammatory markers, improvements in mobility, and decreases in pain. Patients’ outcomes were analyzed using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the occurrence of complications. Radiological outcomes were assessed by fusion and implant stability. The spectrum of the demographic presentation was analyzed. PubMed was searched to find the incidence of POS e and the spectrum of organisms involved. Results: Fifteen patients were operated primarily by interventionalists and four by surgeons among 19 POS e patients who finally underwent TLIF at Stavya Spine Hospital & Research Institute. Organism culture positivity was found in 10 and no culture results were present in 9 cases. All TLIF cases had a follow-up of 52.94±13.66 months (range, 28–71 months). The preoperative back pain VAS improved from 9.47±0.61 (8–10) to 0.42±0.50 (0–1). The leg pain VAS improved from 5.78±4.19 (6–10) to 0.52±0.61 (0–1). The preoperative ODI improved from 87.01±7.70 (73.33–97.79) to 7.36±8.14 (0–26.67). No major complications occurred. Cure of infection and stable reconstruction with fusion were achieved in all patients. Conclusion: POS e has a very low reported incidence. Standardization of training and sterilization would further reduce its incidence. However, aggressive early TLIF in patients with nonresponding POS e produces beneficial results.