The prevention of discitis during discography.

BACKGROUND CONTEXT: Because of the severe complications, discitis represents the most feared complication stemming from discography. Varying needle techniques have been used to prevent discitis, and evidence for the use of intravenous (IV) and/or intradiscal antibiotics is conflicting and often lacking. Consequently, no consensus has been formed for disc infection prevention during discography.

PURPOSE: The objectives of this review are to summarize and integrate all the available basic science, animal, and clinical evidence regarding prevention of infection from discography and to develop areas of future research.

STUDY DESIGN: A comprehensive review of the literature dealing with discitis stemming from discography was conducted.

METHODS: The MEDLINE and SCOPUS databases were searched focusing on prospective and retrospective studies and published case reports on the prevention of discitis. A meta-analysis could not be completed because of the scarcity of data and published randomized controlled trials.

RESULTS: Of the seven articles that specifically focused on the prevention of discitis, no randomized or controlled trials were located. Two prospective, nonrandomized trials, three retrospective case series, and two literature reviews have been published, but no consensus has been formed for the prevention of discitis during discography. Fifteen articles focused on penetration, efficacy, and dosage of antibiotics into intervertebral discs for the prevention of discitis. There are 14 additional articles that report incidences of discitis.

CONCLUSIONS: Based on the available clinical evidence, IV or intradiscal antibiotics during discography have not been conclusively shown to decrease the rate of discitis over sterile technique alone. Animal model research supports prophylactic antibiotic use when used before iatrogenic inoculation of intervertebral discs. Both single- and double-needle techniques when used with stylettes are superior to nonstyletted techniques.