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Post Operative Diskitis

- See: Osteomyelitis of the Spine:

- Discussion:
    - acute infections usually occur between 1-2 wks after surgery;
    - pt who has recently undergone excision of a herniated disc and who presents with localized back pain and spasm following a relatively
          pain-free interval should be suspected;
    - when infection has involved disc space in the postoperative setting, 40% spontaneous fusion can be expected at 2 year follow up;

- Labs:
    - sed rate in osteomyelitis of the spine:
           - following surgical diskectomy, peak elevation of the sed rate occurs around day 4, and levels should return to normal by 2 weeks 

- Bone Scan:
    - bone scan will show increased uptake in the operative site due to normal healing process after an operation;
    - gallium scan is more likely to accurately indicate the extent of infection;

- MRI:
    - gadolinium enhacement of adjacent vertebral bone marrow, as well as enhancement of the disk space and posterior annulus fibrosis;
    - decreased T1 disk uptake and increase disk uptake on T2 images;

- Treatment:
    - depends on level of infection;
          -  if infection does not extend deep to fascia, vigorous irrigation, debridment, & closed suction drainage are performed;
          - when infection extends beneath fascia, debride down to level of definitive surgical infection;
    - bone graft is allowed to remain in place if it is not grossly contamitated;
    - metal implants are usually left in place;
          - early removal of the instrumentation would increase risk of pseudoarthrosis;
    - wound may be left open and packed if needed;;
          - patient can then undergo a delayed primary closure after subsequent irrigation and debridment is performed

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Postoperative discitis. Diagnosis and management.

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