Clinical Efficacies of the Minimal Retroperitoneal Approach for Infectious Spondylodiscitis: A Clinical Case Series

Abstract

An anterior surgical approach for severe infectious spondylodiscitis in the lumbar region is optimal but not always atraumatic. The aim of this study was to evaluate the efficacy and safety of a minimal anterior-lateral retroperitoneal approach, also known as a surgical approach for oblique lumbar interbody fusion, for cases with severe infectious spondylodiscitis with osseous defects. Methods: Twenty-four consecutive patients who underwent anterior debridement and spinal fusion with an autologous strut bone graft for infectious spondylodiscitis with osseous defects were reviewed retrospectively. Eleven patients underwent the minimal retroperitoneal approach (Group M), and 13 underwent the conventional open approach (Group C). Periand postoperative clinical outcomes, that is, estimated blood loss (EBL), operative time (OT), creatine kinase (CK) level, visual analog scale (VAS), and rates of bone union and additional posterior instrumentation, were evaluated, and the differences between both groups were assessed statistically. Results: Mean EBL, serum CK on the 1 st postoperative day, and VAS on the 14 th postoperative day were 202.1 mL, 390.9 IU/L, and 9.5 mm in Group M and 648.3 mL, 925.5 IU/L, and 22.3 mm in Group C, respectively, with statistically significant differences between the groups. There were no statistically significant intergroup differences in OT and rates of bone union and additional posterior instrumentation. Conclusions: Anterior debridement and spinal fusion using the minimal retroperitoneal approach is a useful and safe surgical technique. Although a preponderance of the minimal approach regarding early bone union is not validated, this technique has the advantages of conventional open surgery, but reduces blood loss, muscle injury, and pain postoperatively.

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

“…Several authors have reported clinical and radiological outcomes of lumbar interbody fusion using an antepsoas approach in pyogenic, fungal, and tuberculous infections of the lumbar spine [ 53 , 54 ]. The theoretical advantages of the antepsoas approach in the spinal infection treatment are as follows: (1) direct visualization and access to infectious tissue in the anterior column, allowing thorough debridement and stable anterior column reconstruction; (2) reduction of surgical morbidity when performed in a minimally invasive surgical (MIS) technique; and (3) avoidance of posterior spinal musculature violation during the posterior approach [ 55 ]. For these reasons, antepsoas lumbar interbody fusion combined with percutaneous pedicle screw fixation has shown superior clinical results, including infection control and complication rates, compared to other surgical techniques in previous studies [ 56 ].…”

“…However, surgeons should be more cautious when performing this technique for infections that occur at the L5–S1 level. The involvement of the L5–S1 level has been identified as an independent risk factor for unfavorable outcomes following surgical treatment for lumbar pyogenic spondylitis due to difficult surgical access to the lumbosacral junction [ 55 ]. Transperitoneal ALIF with dissection of the major vessels by a vascular surgeon may be preferred over minimally invasive antepsoas lumbar interbody fusion when vascular adhesion to the L5–S1 IVD is suspected on preoperative MRI.…”

Recurrent Iliopsoas Abscesses Due to Migrated Appendicular Fecalith

“…For minimally invasive removal of the appendicular fecalith in the psoas muscle, we applied a minimal anterolateral retroperitoneal approach, which was used for oblique lumbar interbody fusion. This technique was reported to be also useful in cases of pyogenic spondylitis with severe bone destruction 13 .…”