الفهرس 
Anatomy of the spineOnly 14 pages are availabe for public view
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Abstract
This is a prospective study conducted on twenty patients having postoperative spinal infection managed in the period between June 2017 to June 2019 in the Neurosurgery Department at El Menoufia University hospitals, and Al Haram hospital.
The rationale of this work was to evaluate the different treatment modalities for postoperative spinal infection as a trial to establish a proper algorithm in the management of these cases.
In our study, there were 12 males (60%) and 8 females (40%), where the male: female ratio was 1.5:1. The mean age at time of admission in this study was 47.90 years with standard deviation of ± 11.64 ranged from 27 to 65 years old.
Diabetes and smoking were the most significant risk factors for the development of discitis in our series.
In our study, the pre-management pain Denis score ranging from P5 to P3, 6 patients (30%) were P5, 10 patients (50%) were P 4 and 4 patients (20%) were P3. Among 20 patients, the pre-management ASIA core as follow; 13 patients (65%) were ASIA score E, 5 patients (25%) were ASIA score D, and 2 patients (10%) were ASIA score C.
Among 20 patients, there were 95% of our patients had high CRP distributed as follow 4 patients (20%) with CRP 96, nine patients(45%) with CRP 48, five patients (25%) with CRP 24, one patient (5%) with CRP 12 and just one patient (5%) with CRP 6.
In our study postoperative disc space infections in the lumbar region correspond to the higher ratio of procedures (80%) compared to the thoracic (5 %) or cervical spine (15%) and the most postoperative disc space infection was L4-5 (30%).
In our study, 13 out of 20 patients (65%) underwent surgical management while 7 out of 20 patients (35%) underwent conservative management. We started all conservatively managed patients on a 6-week IV antibiotics regimen followed by 6-week regimen oral antibiotics.
The timing of surgical intervention in our series dated from signs of postoperative spondylodiscitis and second surgery ranged from 2 days to 90 days with a mean of 20.08 days, a median of 7 days and standard deviation of 26.86.
Indications of surgical intervention in our study include MRI finding of a root, spinal cord and/or dura mater compression, epidural abscess with an anterior longitudinal ligament bulge with concomitant vertebral body destruction, neurological deficits, spinal instability due to bone destruction or severe deformity such as kyphosis, and unsuccessful medical treatment with stubborn pain.
Although a wide range of organisms have been associated with spondylodiscitis [105]. In our study 8 patients (40%) were due to Staph. Aureus infection, 1 patient (5%) was due to staph. Epidermidis infection, 2 patients (10%) were due to streptococcus infection, 3 patients (15%) were due to Enterococcus infection, 1 patient (5%) was due to Brucella infection, and finally 5 patients (25%) were due to Nonspecific infection.