Systematic review of the incidence of discitis after cervical discography
Received 21 May 2009; received in revised form 9 December 2009; accepted 25 December 2009. published online 22 February 2010.
Abstract
Background context
Cervical discography is not uniformly used in part because of the fear of discitis. Studies report widely varying rates of this life-threatening infection.
Purpose
The aim of this study was to estimate the incidence of discitis after cervical discography, delineate the consequences of discitis, and identify factors that may influence this complication.
Study design
Meta-analysis.
Methods
Studies pertaining to cervical discography were identified by a literature review and bibliographic search. These were screened for inclusion into the meta-analysis by two reviewers. Data were collected on a wide range of clinical and demographic variables including age, gender, morbidities, number of patients, number of discograms, use of prophylactic antibiotics, type of surgical prep, number of needles used, and the number of patients and discs infected. Primary data were used to calculate the incidence of discitis per patient and per disc.
Results
Fourteen studies were included in the analysis. Both procedural details and demographic information on patients were missing from eight studies. The mean age of patients ranged from 41 to 47 years, and gender distribution varied greatly. Antibiotics use was reported in three studies. Cervical discography was complicated by postprocedural discitis in 22 of 14,133 disc injections (0.15%) and 21 of 4,804 patients (0.44%). Only one patient suffered from an infection at more than one spinal level.
Conclusions
The rate of discitis after cervical discography is relatively low. This can perhaps be further decreased by the use of prophylactic intradiscal antibiotics. Should the ability of cervical discography to improve surgical outcomes be proven, the fear of discitis should not preclude performance of disc provocation.
aDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21205, USA
bPain Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, and Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA
Corresponding author. 550 North Broadway, Suite 301, Baltimore, MD 21205, USA. Tel.: (410) 955-1818; fax: (410) 614-7597.
FDA device/drug status: not applicable.
Author disclosures: none.
This work is funded in part by a Congressional grant from the John P. Murtha Neuroscience and Pain Institute, Johnstown, PA, and the Army Regional Anesthesia & Pain Medicine Initiative, Washington, DC.
ABSTRACT