Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

Lim, Jong Youb; Kim, Sung Min; Jo, Dae Jean; Lee, Tae One

doi:10.3340/jkns.2008.43.1.5

Cited by 16 publications

(16 citation statements)

References 26 publications

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“…Patients of advanced age, with DM, who are immune compromised, or who have undergone surgery or have an established focus of infection must be viewed with a high index of suspicion [4]. Well known pathophysiological mechanisms of spondylodis citis are hematogenous spread of microbial organism into the richly vascularized vertebral metaphyses or through paraspinous venous plexus secondary [6].…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Pyogenic Discitis of Lumbar Region

2014

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Study DesignRetrospective review of patients who had pyogenic discitis and were managed surgically.PurposeTo analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically.Overview of LiteratureSurgical management of pyogenic discitis is still an infrequently used modality of treatment.MethodsA total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16-75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months.ResultsDebridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4-5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients.ConclusionsPyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report.

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Section: Discussionmentioning

confidence: 99%

“…Lim et al [4] also found L4-L5 to be the most common site of infection, and he believed that this is because of a relatively large vertebral body and disc space.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Pyogenic Discitis of Lumbar Region

2014

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“…They recommend an intervention even in the acute phase of infection when they place stress on the radical removal of the infectious focus. Lim et al [20] do not consider the use of the titanium implant to be a contraindication if an infection is present, while the restoration of the spinal sagittal balance is considered to be an advantage. Some authors report lower adhesion of bacteria on the titanium implant's surface as compared to other metals [14,18].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Včelák

Chomiak

Toth

2014

International Orthopaedics (SICOT)

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Purpose This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection. Methods Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed. Results Differences (p<0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45). Conclusions The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B.

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“…In addition, ALIF provided optimal symptomatic improvement and stabilization of the vertebrae in most cases5,11). ALIF has many benefits in postoperative spondylodiscitis management of the previous infected vertebral structures compared to a posterior approach.…”

Section: Discussionmentioning

confidence: 99%

Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis

Kim

Kang

Chin

et al. 2014

J Korean Neurosurg Soc

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ObjectiveTo analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis.MethodsA total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF.ResultsAll of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8±1.1, which improved to 3.2±2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0±14.8, which improved to 34.2±27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic.ConclusionOur results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis.

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Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

Cited by 16 publications

References 26 publications

Surgical Management of Pyogenic Discitis of Lumbar Region

Surgical Management of Pyogenic Discitis of Lumbar Region

Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis

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