Long-Term Clinical and Radiologic Outcome Following Surgical Treatment of Lumbar Spondylodiscitis: A Retrospective Bicenter Study

Abstract

Background and Study Aims Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To date, surgical data are limited to relatively small case series with short-term follow-up data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic long-term outcomes in these patients. Material and Methods A retrospective analysis from two German primary care hospitals over a 9-year period (2005–2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2) minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic outcome was assessed before surgery, at discharge, and at a minimum of 12 months of follow-up. Follow-up included physical examination, laboratory results, CT and MRI scans, as well as assessment of quality of life (QoL) using short-form health survey (SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS) spine score. Results Complete data were available in 70 patients (49 males and 21 females, with an age range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44 patients after 6 years. Thirty-five patients underwent posterior stabilization and decompression alone and 35 patients were operated on in a two-stage 360-degree interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and 11 cases following posterior instrumentation and 360-degree instrumentation, respectively. The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70) due to intraspinal hematoma. Although patients reported a highly impaired pain deception and vitality, physical mobility was unaffected and pain disability during daily activities was moderate. Conclusion Surgical treatment of SD with a staged surgical approach (if needed) is safe and provides very good long-term clinical and radiologic outcome.

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

“…However, in the last years there is an increasing trend towards surgical treatment of newly diagnosed spondylodiscitis as an initial treatment strategy ( 17 – 19 ). Regarding surgical treatment strategies of PS of the thoracolumbar spine, dorsal percutaneous pedicle screw instrumentation with additional surgical debridement of the intervertebral disc space via posterior discectomy or LLIF including cage implantation has been proven to show most favorable outcomes, especially regarding long-term fusion rates ( 17 , 20 – 22 ). For the choice of implants, titanium implants should be favored over polyetheretherketone (PEEK) as higher rates of implant loosening were reported for PEEK in patients treated for spondylodiscitis ( 22 – 24 ).…”

“…A significant rate of postoperative wound healing disorders of 18.5%, which was similar in patients below and over the age of 65 years, was observed in this study. In previous studies, rates of wound healing disorders greatly vary between 2.4% and 12.3% (20,22). The definition of a wound healing disorder might vary between studies-in this study all patients requiring surgical revision under general and local anesthesia were considered.…”