How Do You Know if You Have an Infection after a Discectomy?

Recognizing Post-Discectomy Infection Symptoms

Discectomy surgery, while generally safe and effective for treating herniated discs, carries certain risks, like any surgical procedure. One of the most serious potential complications is postoperative infection, which can occur in approximately one to four percent of cases. Recognizing the signs of infection early is crucial for preventing serious complications and ensuring proper healing. In this article, you will learn how to identify the warning signs of infection after discectomy surgery, understand the different types of infections that can occur, and know when to seek immediate medical attention.

Understanding Post-Discectomy Infections

A discectomy is a surgical procedure where a surgeon removes part or all of a herniated disc that is pressing on spinal nerves or the spinal cord. This form of surgery typically involves making a small incision in the back to access the affected disc material. While the procedure has high success rates, the surgical site creates an entry point where bacteria can potentially enter the body.

Types of Postsurgical Infections

After discectomy surgery, whether it was a cervical or lumbar discectomy, patients may develop different types of infections:

• Superficial wound infections - Affect only the skin and subcutaneous tissue around the incision site. These are typically less serious but still require prompt treatment.
• Deep wound infections - Extend into deeper tissues, including muscles and fascia. These infections are more concerning and may require more aggressive treatment.
• Discitis - An infection of the intervertebral disc space itself. This is the most serious type of post-discectomy infection and can lead to severe complications if not treated promptly.

Fever and Systemic Symptoms

One of the most important indicators of postoperative infection is the development of fever. While some low-grade fever is normal in the first 24–48 hours after surgery, persistent or high fever (above 101.3°F or 38.5°C) beyond this period should raise concern.

Additional systemic symptoms that may indicate infection include:

• Chills and rigors
• Excessive fatigue or weakness
• Loss of appetite
• Nausea or vomiting
• General feeling of being unwell (malaise)

Local Wound Changes

The surgical incision site provides valuable clues about potential infection. Normal postoperative healing involves some initial redness and mild swelling, but certain changes warrant immediate medical attention:

• Increasing redness - While some redness around the incision is expected initially, redness that spreads outward from the wound edges or becomes more intense over time suggests infection.
• Unusual drainage - Any discharge from the wound, especially if it is yellow, green, or has a foul odor, indicates potential infection. Clear or slightly blood-tinged drainage immediately after surgery is normal, but this should decrease over the first few days.
• Excessive swelling - Progressive swelling around the incision site, particularly if it feels warm to the touch, can signal infection.
• Wound separation - If the surgical incision begins to open or separate, this creates additional risk for infection and requires immediate medical evaluation.

Pain Patterns that Raise Concern

Postsurgical pain is expected, but certain pain patterns may indicate infection:

• Increasing pain - While surgical pain typically decreases gradually over time, pain that worsens after initial improvement or fails to respond to prescribed pain medications may suggest infection.
• New-onset back pain - Development of severe back pain, particularly if it is different from preoperative symptoms, could indicate discitis.
• Radicular pain - New or worsening leg pain, numbness, or weakness may suggest deep infection affecting nerve structures, particularly the sciatic nerve.

Early Infections (within 30 Days)

Most post-discectomy infections develop within the first month after surgery. Early infections typically present with obvious symptoms like fever, wound drainage, and increasing pain. These infections are often easier to diagnose because the connection to the recent surgery is clear.

Late Infections (after 30 Days)

Some infections, particularly discitis, can develop weeks or even months after surgery. Late infections may present more subtly with gradual onset of back pain, low-grade fever, and general malaise. These delayed infections can be more challenging to diagnose because patients and healthcare providers may not immediately connect symptoms to the previous surgery.

When to Seek Immediate Medical Attention

Certain symptoms require emergency medical evaluation:

• High fever (above 101.3°F/38.5°C) with chills
• Severe, worsening back pain
• Pus or foul-smelling drainage from the incision
• Red streaking extending from the wound
• Signs of neurological compromise (new weakness, numbness, or bowel/bladder dysfunction)
• Severe headache or neck stiffness (which could indicate meningitis)

Risk Factors for Post-Discectomy Infection

Several factors can increase the risk of developing infection after discectomy:

• Patient-related factors - These include diabetes, obesity, smoking, advanced age, compromised immune system, and poor nutritional status.
• Surgical factors - These encompass longer operative time, revision surgery, use of instrumentation, and multiple-level procedures.
• Postoperative factors - These include poor wound care, early mobilization restrictions not being followed, and certain medications that suppress immune function.

Prevention and Early Detection Strategies

• Proper wound care - Following your surgeon’s wound care instructions precisely is crucial for preventing infection. This typically includes keeping the incision clean and dry, changing dressings as directed, and avoiding submersion in water until cleared by your healthcare provider.
• Monitoring and documentation - Keep a daily log of your temperature, pain levels, and any changes in the surgical site. Take photos of your incision (if possible) to track healing progress and identify concerning changes.
• Follow-up care - Attend all scheduled postoperative appointments, even if you are feeling well. Your surgeon will assess healing progress and can identify early signs of complications you might miss.

Recognizing the signs of infection after discectomy surgery is essential for ensuring optimal recovery and preventing serious complications. While infections are relatively uncommon, early detection and prompt treatment can prevent minor issues from becoming major problems. Always err on the side of caution and contact your healthcare provider if you notice any concerning symptoms. Remember your surgical team is there to support your recovery, and they would rather evaluate a false alarm than miss a real infection. By staying vigilant and following proper postoperative care instructions, you can minimize your risk of complications and maximize your chances of a successful recovery.

Although discectomy surgery is generally a very successful procedure, patients with a larger hole in the outer ring of the disc have a significantly higher risk of reherniation following surgery. Often, the surgeon will not know the size of the hole until he or she begins surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce reherniations, was specifically designed to close the large hole often left in the spinal disc after discectomy. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study time frame. 

If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.