Letter to the Editor: Management of Postoperative Discitis

Dear Editor,

We have read with great interest the clinical report entitled "A retrospective analysis of the management of postoperative discitis: a single institutional experience" in the issue of Asian Spine Journal 2015;9(4):559-564, http://dx.doi.org/10.4184/asj.2015.9.4.559 [1]. We want to share some of our experience with managing discitis.

Discitis should be considered for patients presenting with pain resistant to analgesics after a disc surgery. A neurologic deficit is rare but present in 3% to 4% of patients with discitis. Neurologic deficits are more common in patients with advanced age, diabetes, rheumatoid arthritis, systemic steroid use and Staphylococcus aureus infections [2]. For younger patients with normal immune functions, nearly 75% of patients treated non-operatively improve on their symptoms and achieve spontaneous fusion [345]. We agree with the authors in the treatment method of patients with discitis. We prefer to check the patients for nutrition information, blood urea nitrogen/creatinine levels and liver enzyme values for possible systemic effects of antibiotics use in addition to blood C-reactive protein levels and erythrocyte sedimentation rates.

Once the operative treatment has been decided, several surgical approaches are available. As the authors performed lumbar posterior approach, it is the best way for obtaining thorough discitis debridement. Most surgeons prefer to use instrumentation to restore stability for early mobilization and returning to daily activities. We prefer to add interbody fusion in these cases as to improve the anterior support and stability.

We acknowledge the treatment method of authors in postoperative discitis and thank them on elaborating on a misdiagnosed cause of persistent pain after disc surgery.