Multilevel diskitis and vertebral osteomyelitis after diskography

Mark M. Mikhael, Harold G. Bach, Paul M. Huddleston, Timothy Maus, Elie F. Berbari

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Diskitis is a rare but serious complication following diskography. The signs and symptoms may be easily confused or attributed to patients' preexisting chronic axial degenerative conditions. Unrecognized, it can progress to deep-seated infection with vertebral osteomyelitis. This article presents a case involving a 4-level destructive vertebral osteomyelitis following multilevel diskography despite prophylactic antibiotics and a double-needle technique. A 38-year-old man with radicular symptoms underwent a microdiskectomy at L4-5. Due to only minimal improvement in pain postoperatively, the patient underwent a diagnostic lumbar diskography at L2-3, L3-4, L4-5, and L5-S1 at an outside institution in consideration for repeat surgical treatment. Following this procedure, the patient continued to have debilitating symptoms and presented to our institution, where evaluation revealed elevated inflammatory biomarkers. Magnetic resonance imaging (MRI) suggested diskitis and vertebral osteomyelitis with compression fractures at the 4 levels where the diskography was performed. The patient was successfully treated with parenteral antibiotics targeted at Staphylococcus saccharolyticus, which was isolated in the culture from an open biopsy specimen after an initial percutaneous biopsy was inconclusive. Magnetic resonance imaging is the best radiologic modality for early diagnosis of this complication. This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy. Copyright ® 2009 SLACK Incorporated. All rights reserved.

Original languageEnglish (US)
Number of pages1
JournalOrthopedics
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

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Discitis
Osteomyelitis
Magnetic Resonance Imaging
Anti-Bacterial Agents
Biopsy
Compression Fractures
Therapeutics
Staphylococcus
Signs and Symptoms
Needles
Early Diagnosis
Biomarkers
Pain
Infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Multilevel diskitis and vertebral osteomyelitis after diskography. / Mikhael, Mark M.; Bach, Harold G.; Huddleston, Paul M.; Maus, Timothy; Berbari, Elie F.

In: Orthopedics, Vol. 32, No. 1, 01.01.2009.

Research output: Contribution to journalArticle

Mikhael, Mark M. ; Bach, Harold G. ; Huddleston, Paul M. ; Maus, Timothy ; Berbari, Elie F. / Multilevel diskitis and vertebral osteomyelitis after diskography. In: Orthopedics. 2009 ; Vol. 32, No. 1.
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