INFECTIONS OF VERTEBRAL INTERSPACES AFTER OPERATIONS ON INTERVERTEBRAL DISKS

Abstract

Symptoms of infection in the interverttebral space were recognized in 11 of a series of patients who had undergone surgical removal of a nucleus pulposus. In four patients, the symptoms appeared within four or five days after operation; in two, the symptoms were delayed as long as 10 weeks. The pain was sometimes excruciating and out of all proportion to the physical signs. Fever was not a prominent sign, and the only general laboratory test of significance in this connection was the sedimentation rate. The most important information was gained by aspiration of material from the involved interspace; this yielded material from which the causative organism and its sensitivity to antibiotics could be determined. Progression of the inflammatory process within the interspace to bony fusion appeared inevitable. The process became visible in roentgenograms in the course of a few weeks, and fusion occurred within six months to two years. Such osseous union was observed in all patients followed longer than five months. It was not the result of simple curettage of the intervertebral space, for it rarely, if ever, took place unless infection was present. Three case histories illustrate the type of symptoms encountered. The most important treatment was found to be adequate immobilization of the vertebral column by means of a plaster-of-paris cast or rigid brace.