Elsevier

Surgical Neurology

Volume 63, Issue 6, June 2005, Pages 538-541
Surgical Neurology

Infection
Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature

https://doi.org/10.1016/j.surneu.2004.06.012Get rights and content

Abstract

Background

No previous report has described a progressive, destructive postoperative discitis requiring operative stabilization due to Propionibacterium acnes. The clinical and radiographic features and treatment options associated with discitis due to P acnes are presented in a retrospective case study, as well as a review of the current literature.

Case Description

Seven weeks after a routine lumbar discectomy, the patient presented with clinical findings and radiographic imaging consistent with discitis. Intraoperative cultures obtained from irrigation and debridement of the disc space revealed P acnes, and appropriate intravenous antibiotic treatment was instituted. Approximately 2 months later, the patient showed progression to a destructive osteomyelitis requiring operative stabilization. Nine weeks after stabilization, the patient continued to have lower back pain without radiculopathy. Laboratory values had normalized. Radiographic imaging revealed good instrumentation positioning and adequate fusion. The patient was ambulatory with bilateral articulating ankle foot orthoses and a walker.

Conclusion

The reported case adds to the literature on postoperative discitis due to P acnes and demonstrates that this organism can occasionally be the cause of progressive, destructive osteomyelitis. In addition, we review the incidence, risk factors, and clinical course of discitis due to P acnes.

Introduction

Postoperative discitis is a rare but potentially devastating complication of lumbar discectomy. The incidence of postoperative discitis is reported between 0% and 3.0% [10] and between 0.7% and 0.8% with antibiotic prophylaxis [8]. Possible etiologies include hematogenous spread and direct inoculation [13]. Most cases are due to more virulent organisms such as Staphylococcus aureus and Streptococcus milleri [12]. Propionibacterium acnes, a common skin anaerobe, is an exceedingly rare cause of postoperative discitis, with only a few cases reported in the literature. We report a case of postoperative discitis due to P acnes in a patient with severe psoriasis.

Section snippets

Case report

A 64-year-old male with a history of psoriasis presented with clinical signs and symptoms and imaging studies consistent with a herniated nucleus pulposis at the L5-S1 disc space. His past medical history was also notable for aortic stenosis (status post aortic valve replacement), type II diabetes mellitus, and coronary artery disease. He underwent a routine discectomy (See Fig. 1 for preoperative magnetic resonance imaging [MRI]), which was complicated by an intraoperative dural tear and a

Discussion

Postoperative discitis is a relatively rare but potentially serious complication of discectomy. Incidence varies from 0% to 3.0% with poor subsequent outcomes [10]. The etiology of postoperative discitis is likely due to direct inoculation of virulent organisms intraoperatively, although hematogenous spread is an alternative possibility [13]. The usual pathogenetic organisms are S aureus or epidermidis [10] or streptococci [1]. Risk factors include age, chronic malnutrition, brittle diabetes,

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