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

Abstract

ObjectiveSurgery 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.MethodsThis 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.ResultsThe 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).ConclusionOne‐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.

Minimally Invasive Surgery Oblique Lumbar Interbody Debridement and Fusion for the Treatment of Lumbar Spondylodiscitis

“…The main purposes of surgery for lumbar spondylodiscitis include curing the infection and releasing the symptoms 22 . A previous study reported the efficiency and safety of the OLIF corridor approach in treating lumbar pyogenic spondylodiscitis 19 . Similarly, in this study, Mis-OLIF can relieve the symptoms of patients with lumbar spondylodiscitis, improve the diagnostic efficiency and treatment, and achieve good bony fusion.…”

“…Considering the advantages of OLIF, Mis-OLIF strategy may become an effective surgical approach to treat lumber spondylodiscitis. It has been reported that OLIF combined with posterior internal fixation is effective and safe for single-level spondylodiscitis after ineffective conservative treatment 19 . However, the internal fixation may not be necessary for patients with single-level lumbar spondylodiscitis without spinal deformity or epidural abscess.…”

Influence of cement-augmented pedicle screws with different volumes of polymethylmethacrylate in osteoporotic lumbar vertebrae over the adjacent segments: A 3D finite element analysis

“…Posterior lumbar interbody fusion, the classic surgical procedure to treat lumbar degenerative diseases and thoracolumbar fracture, has been developed for more than 70 years since the initial description in 1944 by Briggs and Milligan [1]. A large number of clinical studies have indicated that posterior-approach fusion and xation can effectively restore sagittal alignment, achieve immediate postoperative stability, and facilitate fusion rates [2][3][4]. However, consensus holds that the stiffness of the instrument relates directly to increased stress on the adjacent disc and facet joints, which could trigger segmental hypermobility and accelerate adjacent segment degeneration (ASD) [5,6].…”

Influence of cement-augmented pedicle screws with different volumes of polymethylmethacrylate in osteoporotic lumbar vertebrae over the adjacent segments: A 3D finite element analysis

“…Posterior lumbar interbody fusion, the classic surgical procedure to treat lumbar degenerative diseases and thoracolumbar fracture, has been developed for more than 70 years since the initial description in 1944 by Briggs and Milligan [1]. A large number of clinical studies have indicated that posterior-approach fusion and fixation can effectively restore sagittal alignment, achieve immediate postoperative stability, and facilitate fusion rates [2][3][4]. However, consensus holds that the stiffness of the instrument relates directly to increased stress on the adjacent disc and facet joints, which could trigger segmental hypermobility and accelerate adjacent segment degeneration (ASD) [5,6].…”