Introduction: We have previously demonstrated significantly elevated IgG titres (ELISA) to a glycolipid antigen found in the cell wall of most gram positive bacteria in patients with discogenic radiculitis (sciatica). This raised the possibility that the inflammation associated with disc protrusion might be initiated or accelerated by the presence of bacteria. Aim of the study: To confirm whether bacteria were present in the disc material harvested at the time of discectomy. To determine whether the presence of bacteria correlated with elevation of Anti Lipid S antibody levels. To compare these results with Antibody levels and disc specimens from patients undergoing surgery for indications other than radiculitis. Methods: This was a prospective study. Recognising the frequency of contamination in clean wound culture stringent aseptic precautions were taken. Disc material was harvested from 108 microdiscectomy patients with sciatica. Disc material was also obtained from 11 patients undergoing discectomy for other indications (trauma, tumour scoliosis). Serology was obtained for all these patients. Results: In the microdiscectomy group 50/112 (45%) had positive cultures after seven days incubation, of which 15 (30%) had positive serology. Thirty-one patients had Propionibacteria, nine Coagulase negative Staphylococci (CNS), six Propionibacteria and CNS, one Corynebacterium and three mixed growth. Sixty-two (55%) patients had negative cultures and all except one had negative serology. There was a significant difference between patients with positive serology and culture compared with those with negative serology and culture (Fischer exact test P<
0.01). In some patients organisms were visible on microscopy prior to culture. Thirteen of those with postive cultures and 25 of those with negative cultures had had one or more epidural injections prior to surgery. Epidural injection was not found to be significantly associated with postive culture. None of the patients undergoing surgery for other indications had positive serology or positive cultures. Conclusion: A significant proportion of patients with discogenic radiculitis have positive cultures with low virulence Gram positive organisms (predominantly Propionibacteria) and in a proportion a corresponding appropriate antibody response.
Introduction: The long term integrity of the intervertebral disc following repair of pars interarticularis defects in the lumbar spine is uncertain. This study was undertaken to clarify this issue. Materials and Methods: 26 patients with symptomatic lumbar spondylolyis underwent a modified Scott repair of the defects, between 1979 and 1993. The early results of these patients were presented to the British Scoliosis Society in 1998. Ten patients have been recalled and reviewed clinically and by MRI investigation at a mean follow-up of 10 years. Results: Eight of the 10 patients are completely asymptomatic and the MRI appearances are normal. The remaining two patients are symptomatic; one has MRI evidence of disc degeneration and the other has normal MRI appearances. Conclusion: Repair of the pars interarticularis defect in symptomatic spondylolysis gives excellent symptomatic relief following surgery. This long term review indicates that it protects the integrity of the adjacent intervertebral disc.
The purpose of this retrospective study was to analyze the indications for spinal instrumentation, report the clinical features, operative details and outcome in 16 patients with active pyogenic spinal infection. Between January 1991 to October 1999, 81 patients with spontaneous pyogenic spinal infection were treated at the authors’ institution. Surgery (other than biopsy) was indicated in 24 patients for neurological deterioration, deformity or instability. Sixteen of these patients were treated with instrumentation in the presence of active spinal infection. Six patients underwent combined anterior and posterior procedures. 10 had a posterior procedure only. Outcomes assessed were control of infection, neurology, fusion, back pain and complications. At a mean follow up period of 26. 9 months, all surviving patients were free of clinical infection. None of the patients had neurological deterioration. All patients who had neurological deficit preoperatively improved by at least one Frankel grade. A solid fusion was achieved in 15 patients. 12/15 patients remained asymptomatic or had very little pain. The remaining 3 patients had mild to moderate back pain. The mean correction of the kyphotic deformity was 18. 92 degrees. Postoperative complications included bronchopneumonia, nonfatal pulmonary embolism and seizures in 3 patients. One patient developed progressive kyphosis despite instrumentation but eventually fused in kyphus. Given early recognition of pyogenic spinal infection, most cases can be managed non-operatively. Our results support that instrumented fusion with or without decompression may be used safely when indicated without the risk of recurrence of infection. Instrumentation facilitates nursing care and allows early mobilisation. For biomechanical reasons, a combined procedure is probably indicated for lesions above the conus. For lesions below the conus, we were able to achieve successful results with posterior approach only.
This raised the possibility that the inflammation associated with disc protrusion might be initiated or accelerated by the presence of bacteria.
Ten of those with positive cultures and fourteen of those with negative cultures had had one or more epidural injections prior to surgery. Epidural injection was not found to be significantly associated with positive culture. None of the patients undergoing surgery for other indications had positive serology or positive cultures.
