Journal de la colonne vertébrale

Supplemental Antibiotic Injections into the Disc Eradicate Lumbar Pyogenic Spondylodiscitis and Reduce Residual Lumbago

Abstract

Motohide Shibayama, Guang Hua Li, Kenzo Shimizu, Yasushi Miura, Shu Nakamura, Minoru Yamada, Zenya Ito and Fujio Ito

The standard treatment for lumbar pyogenic spondylodiscitis is an intravenous antibiotic. If conservative treatment fails, surgery is indicated. However, many patients suffer from residual lumbago after prolonged conservative treatment, and invasive surgery is problematic in poorly conditioned patients. We developed a new treatment in which intravenous antibiotics are supplemented by multiple injections of antibiotic directly into the infected disc. Here we report our experience with twenty adult patients. Shortly after infection was diagnosed, we performed the needle biopsy that we reported followed by direct antibiotic injection into the infected disc. Antibiotic was injected twice weekly until inflammation subsided. The average number of injections was 6.8. Infection was eradicated in all cases. Surgery was needed in two cases (10%): one because of acute paralysis and one because of residual sciatica. We observed no adverse effects. Excluding two cases who died of cancer, we obtained excellent (n=12) or good (n=3) results (83%) in a total of 18 patients evaluated according to Macnab's lumbago criteria at an average of 27.5 months follow-up. The disc height was retained in ten cases during the initial two months of treatment: nine of these patients showed excellent results on Macnab's lumbago scale. We conclude that supplementing standard systemic antibiotic therapy with multiple injections of antibiotic directly into the infected disc provides a safe and effective method of eradicating lumbar pyogenic spondylodiscitis. This treatment also provides an excellent chance of maintaining the disc height, which leads to less residual lumbago.