Post-Surgical Discitis in PIVD: Lumbar Predominance and Age-Related Risk in a Retrospective Study
DOI:
https://doi.org/10.65761/pjcr.2025.2.1.2Keywords:
Postoperative discitis, PIVD, lumbar spine, age-related risk, spinal infection, laminectomy, microdiscectomyAbstract
Postoperative discitis is a rare yet serious complication following surgical treatment for prolapsed intervertebral disc (PIVD). It poses significant challenges in terms of patient outcomes, healthcare costs, and hospital resources. This study aimed to evaluate the incidence, anatomical distribution, surgical factors, and demographic risk factors—especially age—associated with post-surgical discitis across the spinal column. A retrospective study was conducted at Shifa International Hospital, Islamabad, reviewing medical records of 200 patients who underwent surgery for PIVD between January and December 2024. Patients who developed discitis postoperatively were identified. Data collected included demographics, spinal region affected, type of surgery, comorbidities, hospital stay duration, and time to readmission. Descriptive statistics and relative risk analysis (with Haldane-Anscombe correction) were performed to identify trends and risk associations. Out of 200 patients, 23 (11.5%) developed post-surgical discitis. The lumbar region was the most frequently affected (43.5%), with the lumbosacral area involved in 34.8% of discitis cases. Patients aged ≥50 years had a markedly higher risk of developing discitis (RR = 196.57). While fenestration with microdiscectomy was the most common procedure performed, discitis was more frequently observed in patients who underwent modified laminectomy plus microdiscectomy. Diabetes (39.1%) and obesity (30.4%) were common comorbidities among discitis patients. The mean hospital stay for discitis cases was significantly prolonged (14.8 days), and the median readmission interval was 14 days post-discharge. Post-surgical discitis is more prevalent in older adults and predominantly affects the lumbar and lumbosacral spine. Age ≥50, certain surgical techniques, and comorbid conditions like diabetes and obesity were key risk factors. These findings underscore the importance of age-specific and surgery-specific preventive strategies for better postoperative outcomes.
References
1. Bahuguna, D., Agarwal, V., Bhat, A., Pandey, S. J. J. o. M. S., & Research. (2024). Analyzing the immediate and carryover effects of neurodynamics on straight leg raise ranges among acute prolapsed intervertebral disc patients: A randomized control double-blind study. 8(3), 272-280.
2. KAUR, A., CHANDAK, S., PANDA, S., AGARWAL, A., MALHOTRA, A., SINGH, P. J. J. o. C., & Research, D.
(2023). Evaluation of Spinopelvic Parameters in Patients with Different Grades of Intervertebral Disc Degeneration in Lumbosacral Spine vs Normal Asymptomatic Population: A Retrospective Observational Study. 17(6).
3. Jain, S., Shinde, S., Jain, P. J. I. J. o. D. S., & Sciences, H. (2024). Correlation between direction of prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. 7(2), 315-325.
4. Debnath, U. K., Kumar, S., Thakral, R., Chabra, T., & Chatterjee, G. J. I. S. J. (2022). Cauda Equina Syndrome—Retention Type (CESR): Outcome after Delayed Discectomy and Decompression for Lumbar Disc Herniation. 5(1), 112-119.
5. Mohamed, M. S., & Alaa Eldin, A. M. J. T. E. J. o. H. M. (2023). Post-Operative Outcome of icroscopic Discectomy in Patients with Lumber Disc Herniation. 91(1), 5201-5206.
6. Pontikaki, A. E., Pavlidou, K., Polizopoulou, Z., Savvas, I., & Kazakos, G. J. A. (2022). Prophylactic effect of fenestration on the recurrence of thoracolumbar intervertebral disc disease in dogs. 12(19), 2601.
Raza et al. Lumbar Discitis After PIVD Surgery: Age-Related Risk Vol 1, Issue 2 Pak. J. Clin. Res. P a g e | 32
7. Barber, S. M., Sofoluke, N., Reardon, T., Telfeian, A., & Konakondla, S. J. W. N. (2022). Treatment of refractory multilevel thoracic spondylodiscitis using ultra- minimally invasive endoscopic approach for debridement and drainage: a technical note, intraoperative video, and literature review. 167, e456- e463.
8. Tins, B. (2023). Spinal infection. In Musculoskeletal Imaging (pp. 1-25): Springer.
9. Saifee, T., Farmer, S., Shah, S., & Choi, D. J. N. a. q. s. t. (2024). Spinal column and spinal cord disorders. 463- 498.
10. Smith, M. W., & Higgins, J. M. (2024). Silicon Nitride for Spinal Arthrodesis. In Silicon Nitride Bioceramics (pp. 261-288): Springer.
11. Lacasse, M., Derolez, S., Bonnet, E., Amelot, A., Bouyer, B., Carlier, R., . . . Maldonado, I. J. I. D. N. (2023). 2022 SPILF-Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. 53(3), 104647.
12. Miękisiak, G. J. M. (2023). Failed back surgery syndrome: no longer a surgeon’s defeat—a narrative review. 59(7), 1255.
13. Sundgren, P. C., & Van Goethem, J. W. (2022). Spinal Post-operative Complications. In Emergency Radiology of the Head and Spine (pp. 431-441): Springer.
14. Jung, B., Han, J., Song, J., Ngan, A., Essig, D., & Verma, R.
J. O. R. (2023). Interventional therapy and surgical management of lumbar disc herniation in spine surgery: A narrative review. 15, 88931.
15. Yeo, J. J. J. o. Y. M. S. (2024). Failed back surgery syndrome—terminology, etiology, prevention, evaluation, and management: a narrative review. 41(3), 166-178.
16. Boriani, L., Zamparini, E., Albrizio, M., Serani, F., Ciani, G., Marconi, L., . . . Nanni, C. J. C. M. I. R. (2022). Spine infections: the role of fluorodeoxyglucose positron emission tomography (FDG PET) in the context of the actual diagnosis guideline. 18(2), 216-230.
17. Goulart, D. B. J. J. o. B., & Medicines. (2023). Pathogenicity and Antimicrobial Resistance in Coagulase-Negative Staphylococci. 11(5), 9-29.
18. Andre´, C., Van Camp, A. G., Ung, L., Gilmore, M. S., Bispo, P. J. J. A. a., & chemotherapy. (2024). Characterization of the resistome and predominant genetic lineages of Gram-positive bacteria causing keratitis. 68(3), e01247-01223.
19. Billington, Z. J., Henke, A. M., & Gater Jr, D. R. J. J. o. p. m. (2022). Spasticity management after spinal cord injury: the here and now. 12(5), 808.
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