Impact of Intradiscal Saline Wash during Microdiscectomy on Postoperative Pain, Postoperative Spondylodiscitis, and Recurrent Prolapsed Intervertebral Disk: A Study of 200 Consecutive Cases

To mitigate these risks, we propose the use of a 6 French suction catheter and 20 mL syringe to perform an intradiscal saline wash after the primary extruded disk material is removed during microdiscectomy.This technique aims to flush out the residual inflammatory mediators and debris, thereby reducing inflammation, lowering the rate of recurrence, and minimizing the risk of postoperative infection. Materials a n d Methods Study DesignThis study is a prospec tive obser vational analysis of 200 consecutive patients undergoing one-or two-level lumbar microdiscectomy under spinal anesthesia at a single center from January 2021 to December 2023.All patients included in the introduction Lumbar microdiscectomy is a widely accepted surgical intervention for treating herniated lumbar disks.Weinstein et al. 1 in a foundational study compared surgical and nonoperative treatments for lumbar disk herniation, providing context for the standard outcomes of microdiscectomy.Despite the overall success of the procedure, some patients experience persistent or recurrent pain due to residual inflammation or recurrence of disk herniation.Additionally, the risk of postoperative infections such as spondylodiscitis, although rare, remains a concern.McGirt et al. 2 discusses surgical site infections in lumbar surgery, reinforcing the importance of adjunct techniques to minimize infection risks, analogous to the use of saline wash in this study.Postoperative spondylodiscitis (POSD) is a rare but serious complication following lumbar spine surgeries, including microdiscectomy.The reported incidence of POSD after lumbar discectomy varies across studies, with rates ranging from 0.2 to 3.6%.Additionally, the incidence of POSD after lumbar discectomy has been reported to be <1% in Western countries but ranges from 4 to 10% in India, suggesting regional variations in occurrence.3 Inflammatory cytokines such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α), and other mediators are released into the disk space after disk herniation, which contribute to persistent pain and neuroinflammation.The removal of the extruded disk material typically addresses the mechanical compression of nerve roots, but these inflammatory mediators may remain in the nucleus pulposus and surrounding tissues, potentially exacerbating postoperative pain and contributing to recurrence.Doita et al. 4 explore in their paper the immunohistologic components of herniated disks, including the inflammatory milieu that can contribute to poor postoperative outcomes.