J Korean Soc Spine Surg.  2010 Mar;17(1):18-25. 10.4184/jkss.2010.17.1.18.

One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

Affiliations
  • 1Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Sungnam, Gyounggi, Korea. hefirst@dmc.or.kr

Abstract

STUDY DESIGN: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis.
OBJECTIVES
To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. SUMMARY OF LITERATURE REVIEW: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach.
MATERIALS AND METHODS
Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings.
RESULTS
The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9degrees.
CONCLUSION
One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.

Keyword

Lumbar spine; Spondylodiscitis; Posterior interbody fusion; Instrumentation

MeSH Terms

Anti-Bacterial Agents
Debridement*
Discitis*
Follow-Up Studies
Hospitalization
Humans
Retrospective Studies
Transplants
Anti-Bacterial Agents

Figure

  • Fig. 1. A 50-year-old male with L2-3 pyogenic spondylodiscitis (S. aureus). (A) Preoperative lateral plain radiograph shows destructive change and space narrowing in lumbar 2, 3 vertebrae. (B) T2-weighted MR image, (C) T1-weighted MR image, (D) Contrast-enhanced fat suppression MR image shows end plate destruction and epidural abscess. (E) Contrast-enhanced T1-weighted axial MR image demonstrating epidural abscess and left psoas abscess (F) Lateral radiograph after operation shows posterior debridement, bone graft and posterior instrumentation with infected body. (G) Lateral radiograph obtained 1 year after operation shows bony fusion.

  • Fig. 2. A 47year-old man with L5-S1 pyogenic spondylitis. (A) Preoperative lateral plain radiograph shows destructive change, disc space narrowing in L5-S1 vertebrae. (B) T2 weighted MR image, (C) Contrast-enhanced T1-Weghted MR image (D) Fat suppression MR image demonstrating end plate destruction and epidural abscess. (E, F) Contrast-enhanced T1-weighted axial MR image showing inflammatory change and epidural abscess, (G) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation at infected vertebral body. (H) Lateral radiograph obtained 5 years after operation shows bony fusion.

  • Fig. 3. A 59-year-old female who had DM, HTN, and ESRD with L45 pyogenic spondylitis. (A) Initial lateral plain radiograph shows destructive change, disc space narrowing in L4-5 vertebra. (B) T2-weighted saggital MR image. (C) Contrast-enhanced T1-weighted MR image. (D) T1-weighted axial MR image. (E) T2-weighted axial MR image demonstrating epidural abscess and both psoas abscess. (F) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation (G) The 6-months later, lateral plain radiograph shows the progression of pyogenic spondylitis. More desctuctive vertebral body with L4 retrolisthesis.


Reference

1.Arnold PM., Baek PN., Bernardi RJ., Luck EA., Larson SJ. Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol. 1997. 47:551–61.
Article
2.Klockner C., Valencia R. Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine. 2003. 28:1036–42.
3.Eismont FJ., Bohlman HH., Soni PL., Goldberg VM., Freehafer AA. Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am. 1983. 65:19–29.
Article
4.Redfen RM., Miles J., Banks AJ., Dervin E. Stabilisation of the infected spine. J Neurol Neurosurg Psychiatry. 1988. 51:803–7.
5.Hadjipavlou AG., Mader JT., Necessary JT., Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine. 2000. 25:1668–79.
Article
6.Osenbach RK., Hitchon PW., Menezes AH. Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol. 1990. 33:266–75.
Article
7.Fukuta S., Miyamoto K., Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine. 2003. 28:302–8.
Article
8.Doi T., Miyauchi A., Hashimoto K, et al. Current problems with pyogenic spondylitis. Clin Orthop. 1998. 33:727–735.
9.Krö del A., Krü ger A., Lohscheidt K., Pfahler M., Refior HJ. Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord. 1999. 12:17–26.
10.Przybylsky GJ., Sharan AD. Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg. 2001. 94:1–7.
11.Fang D., Cheung KM., Dos Remedios ID., Lee YK., Leong JC. Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion. J spinal Disord. 1994. 7:173–80.
12.Rath SA., Neff U., Schneider O., Richter HP. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery. 1996. 38:926–33.
Article
13.Ha KY., Shin JH., Kim KW., Na KH. The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis. Spine. 2007. 32:1856–64.
Article
14.Moon MS., Woo YK., Lee KS., Ha KY., Kim SS., Sun DH. Posterior instrumentation and anterior interbody for tuberculosis kyphosis of dorsal and lumbar spines. Spine. 1995. 20:1910–6.
15.Lee JS., Suh KT. Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br. 2006. 88:765–70.
Article
16.Ahn DK., Jeong KW., Kwon BK, et al. Operative treatment of lumbosacral spondylitis through a posterior-only approach. J Korean Orthop Assoc. 2005. 40:868–74.
Article
17.Hodgson AR., Stock FE. Anterior spinal fusion. A preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Clin Orthop Relat Res. 1994. 300:16–23.
18.Dickman CA., Fessler GR., MacMillan M., Haid RW. Transpedicular screw-rod fixation of the outcome in 104 cases. J Neurosurg. 1992. 77:860–70.
19.Oga M., Arizono T., Takasita M., Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine. 1993. 18:1890–4.
20.Chung YG., Ha KY. Adherence and biofilm formation of staphylococcus epidermidis and Mycobacterium tuberculosis on spinal implant. J Korean Soc Spine Surg. 1999. 6:47–56.
21.Kim BS., Jeon WB., Choi CS., Kim YJ. Pyogenic spondylitis. J of Korean orthopedics. 1976. 11:477–82.
22.Lee KY., Sohn SH., Hwang KS. Comparison of pyogenic and Tuberculous Spondylitis. J Korean Soc Spine Surg. 1999. 6:443–50.
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