Medical and Surgical Management of Spontaneous and Postoperative Diskitis

摘要

Spinal infection is an uncommon but important clinical problem that often requires aggressive medical and surgical management. When spinal infection is recognized early and treated appropriately, a full recovery often can be expected. Treatment and outcome of spontaneous (pyogenic and nonpyogenic) and postoperative spondylodiskitis are discussed. The principles of conservative treatment are establishment of accurate microbiological diagnosis, treatment with specific antibiotics, spinal immobilization, and careful monitoring for spinal instability or neurologic deterioration. The principles of surgical treatment are to obtain multiple intraoperative cultures of bone and soft tissue, perform a thorough debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation.