Management of Postoperative Discitis with Debridement and Novel Technique of Local Antibiotic Instillation: Functional Outcomes from a Resource-Limited Setting

-BACKGROUND: Patients in low-and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting. -METHODS: This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008-2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imaging-confirmed discitis. After non-response or deterioration following intravenous antibiotics, patients -nderwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year. -RESULTS: Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean +/- SD) decreased from 9.25 +/- 0.75 preoperatively to 0.67 +/- 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.019.15, P < 0.001). JOA scores (mean +/- SD) improved from 4.5 +/- 2.94 to 26.42 +/- 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57-23.26, P < 0.001). KirkaldyWillis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up. -CONCLUSIONS: In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.

Automated summary

This study investigated the outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in a low- and middle-income country (LMIC) setting. The results showed that patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation in LMICs.