Role of Intradiscal Gentamycin Wash on Incidence of Postoperative Discitis

Abstract

Objective:  Postoperative discitis (POD) is a serious yet uncommon side effect of lumbar discectomy with long-term morbidity, delayed recovery, and high cost of treatment. Local prophylaxis is a viable alternative to systemic antibiotics, which fail to reach a therapeutic level in the avascular disc. This study sought to assess the efficacy of intradiscal gentamycin wash in the prevention of POD.

Material and Methods:  A retrospective study was conducted on 160 patients (58% male) who underwent lumbar discectomy between December 2023 and January 2025. The patients were categorized into Group A (n=70), without intradiscal wash, and Group B (n=90), with intradiscal wash (gentamycin 80 mg). All were then clinically and radiographically followed for 12 months. The incidence of POD was the main outcome, and clinical, radiological, and laboratory characteristics were analyzed in patients with POD.

Results:  POD occurred in 5 patients (3.1%). Group A had 4 cases (5.7%), whereas Group B had 1 case (1.11%), showing a significant reduction (p < 0.05; RR = 5.14). All POD cases were managed conservatively with intravenous administration of antibiotics, use of bracing, and analgesics, and they had full recovery within 6-12 months without surgery.

Conclusion:  Intradiscal gentamycin wash is an easy, safe, and cost-effective adjuvant that has proven to be significantly effective in the reduction of POD after lumbar discectomy. Larger prospective trials are indicated to establish a role for its routine clinical use.