Transpedicular curettage and drainage of infective lumbar spondylodiscitis: technique and clinical results

Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study

This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.

Infectious Spondylitis Caused by Streptococcus gordonii

Infectious spondylitis is a rare but severe disease of the spine caused by bacteria or other pathogens. Particularly in immunocompromised patients, a definitive source of infection often remains uncertain. Among many pathogens, Streptococcus gordonii, a normal oral flora, is a very rare pathogen in infectious spondylitis. Only a few articles have reported infectious spondylitis caused by Streptococcus gordonii. To the best of our knowledge, there have been no reports of surgically treated infectious spondylitis caused by Streptococcus gordonii. Hence, in the current report, we present the case of a 76-year-old woman with known type 2 diabetes who was transferred to our medical center due to infectious spondylitis caused by Streptococcus gordonii following an L1 compression fracture and underwent an operation for treatment.

Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Pyogenic Spondylodiscitis

OBJECTIVE

Skipped multifocal pyogenic spondylodiscitis is a rare presentation of spinal infection. In our institution, we used the single posterior approach for circumferential debridement and anterior reconstruction with fibular allograft for treatment. This study aimed to ascertain the viability and reliability of this technique for these difficult cases.

METHODS

Nine patients with skipped pyogenic spondylodiscitis who received our treatment method from January 2012 to December 2019 were enrolled in this study. Visual analog scale scores, causative agents, laboratory data, comorbidities, and complications were recorded. The patients' clinical conditions were evaluated based on modified Brodsky's criteria, visual analogue scale, and Oswestry Disability Index.

RESULTS

All the patients achieved infection eradication without repeat surgical treatment. The average visual analog scale score was 8.4 (range, 8-9) before operation, which decreased to 1.9 (range, 1-3) 1 year after the surgery. No patient experienced severe complications such as neurologic deterioration or fixation failure. All patients achieved a good or excellent outcome based on modified Brodsky's criteria. The Oswestry Disability Index improved from 80.4 (range, 70-86) preoperatively to 25.1 (range, 20-32) 1 year after the surgery.

CONCLUSIONS

In our case series, good clinical outcomes and high successful rates could be achieved through the single-stage posterior-only approach. This could be considered an alternative method to manage patients with skipped pyogenic spondylodiscitis.

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

Background

Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.

Methods

Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).

Results

All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.

Conclusions

In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

A New Surgical Strategy for Infective Spondylodiscitis: Comparison Between the Combined Antero-Posterior and Posterior-Only Approaches

STUDY DESIGN

Retrospective comparative study.

OBJECTIVE

To investigate the radiographic and clinical effectiveness of surgical treatment using a posterior-only approach, as compared with a combined antero-posterior approach, in patients with infective spondylodiscitis.

SUMMARY OF BACKGROUND DATA

Spondylodiscitis is the most common infectious disease of the spine. There is currently no consensus over the surgical approach, use of bone graft, and type of instrumentation for optimal treatment of infective spondylodiscitis.

METHODS

Seventy-nine patients who received surgical treatment for infective spondylodiscitis were divided into a combined antero-posterior (AP) group and a posterior-only (P) group. Significant differences in pre- and postoperative radiographic and clinical characteristics between the two groups were identified, and univariate and stepwise multivariate logistic regression analyses were used to determine the factors that affected the decision for treatment approach between the two groups.

RESULTS

Preoperatively, initial height loss, wedge angle, and kyphotic angle were significantly higher in the AP group. However, estimated blood loss, operation time, and last visual analogue scale score for back pain were significantly lower in the P group. There was no difference in postoperative time to reach solid fusion. Postoperative corrected kyphotic angle was 12.8° in the AP group and 5.3° in the P group. The regional wedge angle was identified as a factor that influenced use of the combined antero-posterior approach, with a sensitivity of 60%, and specificity of 89.8% at the optimal cut-off value of 8.2°.

CONCLUSION

Interbody fusion with long-level pedicle screws fixation through a posterior-only approach was shown to be as effective as a combined antero-posterior approach for the surgical treatment of infective spondylodiscitis. A posterior-only approach is recommended when the regional wedge angle of the collapsed vertebra is less than 8.2°.

LEVEL OF EVIDENCE

4.

Emphysematous osteomyelitis of the spine: A rare case report

RATIONALE

Emphysematous osteomyelitis is a rare disease caused by gas-forming bacteria. But only 45 cases have been reported in the literature since then.

PATIENT CONCERNS

A 72-year-old female presented to our hospital with severe lower back pain that aggravated 4 days ago.

DIAGNOSES

Computed tomography (CT) revealed intraosseous mottled air in the T12 and L1 vertebral bodies and epidural space. The enhanced T1 and T2 magnetic resonance imaging scans showed heterogeneous signal intensity of vertebral bodies, suggestive of emphysematous osteomyelitis.

INTERVENTIONS

Surgery was performed to identify culture strains and to remove emphysematous lesions of the vertebral body using extensive transpedicular irrigation.

OUTCOMES

Escherichia coli (E coli) was identified in the surgical specimen, and intravenous antibiotic therapy was continued with cefotaxime. The patient had a significant decrease in lower back pain after the surgery and the final CT scan before discharge revealed significantly decreased air at T12 and L1 vertebral bodies and no air density in the epidural space.

LESSONS

We present a patient diagnosed with emphysematous osteomyelitis in vertebral bodies caused by E coli and successfully treated with surgical intervention.

One-stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

Objective

Surgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis.

Methods

This was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T₁₂ and L₅. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively.

Results

The mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05).

Conclusion

One‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.

Continuous Epidural Irrigation and Drainage Combined with Posterior Debridement and Posterior Lumbar Inter-Body Fusion for the Management of Single-Segment Lumbar Pyogenic Spondylodiscitis

Purpose: To observe the clinical curative effect of continuous epidural irrigation combined with posterior debridement and posterior lumbar inter-body fusion with instrumentation for the therapy of single-segment lumbar pyogenic spongdylodiscitis. Methods: From June 2010 to November 2013, surgical treatment was performed in 18 patients with pyogenic spondylodiscitis. The surgical indications were progressive biomechanical instability, epidural abscesses, deterioration of neurologic status, and intractable back pain. All these patients received posterior decompression with posterior instrumentation, debridement of infected tissue, and inter-body fusion. Visual Analogue Scale (VAS) scores were used to assess clinical outcomes. The neural function was evaluated by the Frankel grading system. Laboratory and radiologic results were recorded during clinical follow-up for at least one year. Results: The average follow-up period was 18 months after the operation. The VAS scores decreased from an average of 7.1 points before the procedure to 2.6 points after operation. The neurologic deficits of all the patients were recovered to Frankel grade E. All of the examined laboratory parameters were normalized gradually. Imaging-documented fusion was achieved in each patient, and no implants failure was noted. No patients showed any evidence of recurrence or persistence of infection. Conclusion: In carefully selected patients, single-segment lumbar pyogenic spondylodiscitis can be cured successfully with continuous epidural irrigation and drainage combined with posterior debridement and posterior lumbar inter-body fusion. Instrumentation could provide immediate stability and reconstruction of the spine column, and the presence of instrumentation did not result in any persistence or recurrence of infection. Continuous epidural irrigation and drainage is an effective method facilitating the elimination of residual infection.

Transforaminal Lumbar Interbody Fusion with Antibiotics Delivered by CaSO4 Drug Carrier System for Pyogenic Spondylodiscitis

BACKGROUND

Spondylodiscitis is a challenging spinal disorder that requires surgical treatment only as a last resort. The use of various procedures and instruments remains controversial. In this retrospective study, we reported the safety and efficacy of a CaSO₄ drug carrier system for the transforaminal lumbar interbody fusion (TLIF) procedure for lumbar pyogenic spondylodiscitis.

METHODS

Thirty-four patients with lumbar spondylodiscitis underwent TLIF. CaSO₄ beads carrying vancomycin and gentamycin were implanted in the trajectory of screws and disc spaces. We measured markers of inflammation, scores of neurologic recovery, and quality of life. The fusion status was assessed at final follow-up and the correction of local and total lordotic angle was calculated.

RESULTS

The patients were followed up for at least 12 months (range, 12-24 months). At 3 months follow-up, C-reactive protein levels and erythrocyte sedimentation rate returned to normal with no relapse. Nineteen patients with American Spinal Injury Association grade D preoperatively returned to American Spinal Injury Association grade E. The improvement on the visual analog scale and Oswestry Disability Index was 66.9% and 84.9%, respectively. At 12 months follow-up, 67.6% of patients achieved definitive union. The corrections of total and local lordotic angle were 10.02° ± 8.77° and 7.7° ± 8.75°, respectively. The rate of achievement of satisfactory Kirkaldy-Willis functional criteria was 85.3%.

CONCLUSIONS

The combined use of single-level TLIF with a CaSO₄ drug delivery system was safe and effective for treatment of pyogenic lumbar spondylodiscitis. The system promoted reduction of inflammation with limited fixed segments without a negative impact on fusion status. This procedure may be considered a novel choice for spondylodiscitis, with more efficacy and less invasion.

[Application of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis]

Objective

To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis.

Methods

Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion.

Results

The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002).

Conclusion

One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.

Percutaneous Transpedicular Interbody Fusion Technique in Percutaneous Pedicle Screw Stabilization for Pseudoarthrosis Following Pyogenic Spondylitis

This report introduces a percutaneous transpedicular interbody fusion (PTPIF) technique in posterior stabilization using percutaneous pedicle screws (PPSs). An 81-year-old man presented with pseudoarthrosis following pyogenic spondylitis 15 months before. Although no relapse of infection was found, he complained of obstinate low back pain and mild neurological symptoms. Radiological evaluations showed a pseudoarthrosis following pyogenic spondylitis at T11–12. Posterior stabilization using PPSs from Th9 to L2 and concomitant PTPIF using autologous iliac bone graft at T11–12 were performed. Low back pain and neurological symptoms were immediately improved after surgery. A solid interbody fusion at T11–12 was completed 9 months after surgery. The patient had no restriction of daily activity and could play golf at one year after surgery. PTPIF might be a useful option for perform segmental fusion in posterior stabilization using PPSs.

When and how to operate on spondylodiscitis: a report of 13 patients

PURPOSE

Conflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients.

MATERIALS AND METHODS

We retrospectively studied the files of 153 patients with spondylodiscitis treated at our institution from 2002 to 2012. The approach included MR imaging of the infected spine, isolation of the pathogen with blood cultures and/or biopsy, and further conservative or surgical treatment. The mean follow-up was 6 years (range 1-13 years). We evaluated the indications, timing (when), and methods (how) for surgical treatment, and the clinical outcome of these patients.

RESULTS

Orthopedic surgical treatment was necessary for 13 of the 153 patients (8.5 %). These were patients with low access to healthcare systems because of low socioeconomic status, third-country migrants, prisoners or intravenous drug use, patients in whom a bacterial isolate documentation was necessary, and patients with previous spinal operations. The most common pathogen was Mycobacterium tuberculosis. The surgical indications included deterioration of the neurological status (11 patients), need for bacterial isolate (10 patients), septicemia due to no response to antibiotics (five patients), and/or spinal instability (three patients). An anterior vertebral approach was more commonly used. Nine of the 13 patients had spinal instrumentation in the same setting. Improvement or recovery of the neurological status was observed postoperatively in all patients with preoperative neurological deficits. Postoperatively, two patients deceased from pulmonary infection and septicemia, and heart infarction. At the last follow-up, patients who were alive were asymptomatic; ten patients were neurologically intact, and one patient experienced paraparesis. Imaging showed spinal fusion, without evidence of recurrent spondylodiscitis. Complications related to the spinal instrumentation were not observed in the respective patients.

CONCLUSIONS

Conservative treatment is the standard for spondylodiscitis. Physicians should be alert for Mycobacterium tuberculosis spondylitis because of the low access to healthcare systems of patients with low social and economic status. Surgical indications include obtaining tissue sample for diagnosis, occurrence or progression of neurological symptoms, failure of conservative treatment, large anterior abscesses, and very extensive disease. Thorough debridement of infected tissue and spinal stability is paramount. The anterior approach provides direct access and improved exposure to the most commonly affected part of the spine. Spinal instrumentation is generally recommended for optimum spinal stability and fusion, without any implant-related complications.

Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine

BACKGROUND

Spinal tuberculosis is the most common form of skeletal tuberculosis. Various approaches have been described for surgical management of spinal tuberculosis, but many entail wide exposures with attendant morbidity; whether minimally invasive surgical (MIS) approaches are suitable is unknown.

QUESTIONS/PURPOSES

We evaluated (1) neurologic results, (2) radiographic results, and (3) complications in patients with thoracic and lumbar spinal tuberculosis treated with two MIS approaches.

METHODS

We retrospectively evaluated 22 patients with thoracic and lumbar tuberculosis managed surgically from October 2008 to February 2011 using MIS methods; one patient was lost to followup, leaving 21 patients with a minimum followup of 15 months (mean, 30 months; range, 15-59 months) for analysis. MIS approaches were used for patients with disease below D6 and minimum pedicle diameters of 4.5 mm to permit percutaneous screw placement. The MIS approach was divided into two groups depending on the extent of destruction of the vertebral body: a posterior-only group (n = 9), where posterior transpedicular decompression sufficed, and the hybrid group (n = 12), requiring anterior débridement and ventral-column reconstruction by conventional or mini-open thoracotomy. All but two patients with more than two contiguous bodies involvement underwent MIS posterior fixation by percutaneous transpedicular screws. Plain radiographs were evaluated for deformity correction and correction maintenance. Neurologic recovery and complications were ascertained by chart review.

RESULTS

All patients with neurologic deficits recovered completely with no motor deficits at followup; 13% improved by three grades, 53% by two grades, and 33% by one grade. Mean correction was 2.5° (thoracic) and 8° (lumbar) in the posterior-only group and 4.2° in the hybrid group. Some correction loss occurred with healing (2° and 1.6° in the posterior-only and hybrid groups, respectively), but in none of those who had fixation did this progress to more than preoperative status. Two of 22 patients (9%) had complications. One had a malposition of L5 screw causing painful radiculopathy without motor deficit and required repositioning. The other had an intraoperative dural tear repaired by onlay fascial patch and cerebrospinal fluid diversion. There were no approach-related complications, neurologic deterioration, or implant fatigue at last followup.

CONCLUSIONS

We found evidence of neurologic recovery, avoidance of deformity progression, and few complications with these MIS approaches. Comparative trials are called for between open and MIS approaches for patients with spinal tuberculosis.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis

BACKGROUND

Hematogeneous infectious spondylodiscitis usually occurs in older immunocompromised patients with other comorbidities. They are usually unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method of transpedicular curettage and drainage was suggested. This study was designed to compare the surgical outcomes for the treatment of hematogeneous infectious spondylodiscitis between transpedicular curettage and drainage technique and conventional combined anterior and posterior surgery.

MATERIALS AND METHODS

Between January 2002 and July 2011, 26 patients underwent surgical treatment for hematogeneous infectious spondylodiscitis. The patients were classified into two groups depending on surgical modality: a transpedicular curettage and drainage (TCD) group and a combined anterior and posterior surgery (CAPS) group.

RESULTS

The TCD group consisted of 10 patients (mean age 68.0 years), and the CAPS group consisted of 16 patients (mean age 58.4 years). The mean postoperative followup periods were 36.9 (months) in the TCD group and 69.9 (months) in the CAPS group. The operation time was 180.6 ± 33.6 minutes in the TCD group and 332.7 ± 74.5 minutes in the CAPS group (P < 0.05). Postoperative independent ambulation began at postoperative 4.9 ± 2.4 days in the TCD group but at postoperative 15.1 ± 15.3 days in the CAPS group (P < 0.05). The postoperative hospital stays were 19.9 ± 7.8 days in the TCD group and 35.4 ± 33.3 days in the CAPS group (P < 0.05). The level of C-reactive proteins decreased significantly in both groups after surgery (P < 0.05).

CONCLUSION

Transpedicular curettage and drainage technique proved to be a useful technique for treating hematogeneous infectious spondylodiscitis in patients who were in poor heath with multiple comorbidities unable to undergo the conventional combined anterior and posterior surgery in a single day in terms of earlier ambulation, shorter hospitalization and similar clinical success rate.

[Dorsolateral access and interbody spinal fusion in spondylodiscitis of the thoracolumbar spine (TLIF technique)]

SURGICAL GOAL: Resolve infection and achieve primary stability of instrumentation and permanent fusion of the affected spinal segment by means of debridement of the focus of infection. Defect-filling using autologous/allograft bone or a spacer, as well as immobilization by means of dorsal instrumentation.

INDICATION

Acute and chronic thoracolumbar spondylodiscitis.

CONTRAINDICATIONS

Purely epidural abscesses requiring only decompression (fenestration). Defects whose size make a ventral approach necessary.

SURGICAL TECHNIQUE

Classic dorsal approach to the thoracolumbar spine. Pedicle placed using screws depending on the size of the spinal defect for mono-, bi-, or multisegmental spinal fusion. Exposure performed at the level of the infected spinal disc or vertebral body on the more strongly affected side. Focus of infection removed. Depending on the degree of infection, defect filling is carried out using autologous bone or cancellous allograft, followed by rod assembly.

POSTOPERATIVE MANAGEMENT

Back brace-free follow-up treatment, physiotherapy and back training. Antibiotic administration until inflammation values fall within the normal range, or for at least 14 days.

RESULTS

Successful fusion of affected segments, including resolution of infection, is reported in over 90% of cases described in the literature. The revision rate among our mostly multimorbid patient group with an average age of 66 years was 16%. Of 39 of the 114 (34%) patients with preoperative neurological deficits, 26 (66%) demonstrated postoperative regression. Nine patients (23%) showed no improvement, whilst exacerbation of existing neurological deficits was seen in four patients (11%). Staphylococcus was the major pathogen in 34% of cases.