One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis

Zhang, Tao; Hu, Jianzhong; Wu, Jianhuang; Liu, Jinyang; Ni, Shuangfei; Duan, Chunyue

doi:10.1016/j.aott.2018.04.004

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…Having to use drainage during posterior debriding to reduce the recurrence rate of infection implies that debridement via the single posterior approach is not sufficient. To reduce the recurrence rate, many orthopaedists have suggested radical debridement using the posterior approach, which theoretically results in excessive removal of healthy bone. Exposing via the OLIF corridor, the lesion can be clearly viewed and debrided up to the healthy bone, which results in precise debridement without any residual lesion or excessive removal of healthy bone.…”

Section: Discussionmentioning

confidence: 99%

“…However, the best surgical approach remains controversial. An anterior only approach debridement, a posterior only approach debridement, and a combined anterior–posterior debridement have been reported; however, these approaches are associated with certain risks. Debridement through the posterior only approach damages the posterior structure, which finally results in instability of the spine and greater loss of sagittal balance .…”

Section: Introductionmentioning

confidence: 99%

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

Tong

Liu

Fan

et al. 2019

Orthopaedic Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Tong

Liu

Fan

et al. 2019

Orthopaedic Surgery

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“…Posterior approach could give better kyphotic deformity correction and vertebral stabilization, less complications and less surgical invasiveness [16]. Meanwhile, the infected intervertebral discs, vertebral endplates, and vertebral body tissues could be adequately debrided through a posterior-only approach to assure the excellence of the radiographic and clinical results [13,15]. But a considerable portion of authors believed that the posterior-only approach has the drawbacks of insu cient removal of infected tissue compared with the anterior approach[26].…”

Section: Discussionmentioning

confidence: 99%

“…Anterior, posterior and combined approaches have been used for the treatment of spondylodiscitis [9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Combination Use of Antibiotic-Loaded Calcium Sulfate Beads in Spinal Surgery for Patients with Spondylodiscitis：A Clinical Retrospective Study

Tang¹,

Li²,

Wang³

et al. 2021

Preprint

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Background. Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after infection site debrided by Quadrant channel combined with percutaneous fixation through a single-stage posterior approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods. This study collected 32 patients’ clinical data of whom had spine spondylodiscitis treated in our department from July of 2015 to August of 2020. The Demographic data included age, gender, involved segment and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results. The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65–10%. Cobb angle was significantly improved and could be maintained at final follow-up. Solid bone fusion was achieved in all patients. There were no recurrences of infection in our study. Conclusions. The procedure we proposed is effective in the treatment of spondylodiscitis, the infection site can be debrided and controlled exactly, and spinal stabilization can also be achieved.

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“…However, these are very useful parameters for following the response to therapy [36]. Blood culture obtained during a fever spike are positive in upto onethird of patients and are 85% accurate in the identification of pathogen in case of postoperative discitis [31].…”

Section: Risk Factorsmentioning

confidence: 99%

Post-Discectomy Pyogenic Lumbar Discitis: A Literature Review

Patel¹,

Modi²

2022

bbj

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Introduction: Post-disctectomy pyogenic lumbar discitis is not common condition in contrast to postoperative wound infection but its presentation is typically non-specific, which can lead to delay in diagnosis and its treatment. In this condition, patients present with low back pain after symptoms free interval. The diagnosis can be established with symptoms, examination, laboratory studies and radiological investigations. Purpose: The aim of this literature review is to evaluate available articles about post- discectomy lumbar spondylodiscitis. we analyse the incidence, risk factors, causative organisms, diagnosis modalities (including clinical features, blood and radiological investigations), management strategies (conservative and surgical) and prevention for postoperative lumbar spondylodiscitis in the published literature. Material and methods: We have reviewed literature articles available on topic of post-discectomy lumbar discitis in PubMed, MEDLINE and Google scholar only in English language; and have been published from the year 2000 onwards. Results: This incidence rate of post-operative discitis is 0.94%. The age range was 38-56 years with a mean age of 45.18±4.17 years. Mean interval between discectomy and establishment of diagnosis was 2-8 weeks. Of all the patients included 61.93% were males and 38.07% were females. The most common organism isolated is staph. aureus (including methicillin sensitive and resistant staph. aureus). Majority of patients were initially treated conservatively. The surgical treatment in patients who fail to respond to conservative management has been demonstrated. Our study showed 40.1% excellent results, 56% good result and 3.9% fair and poor result at final follow up. Conclusion: Although the incidence of post-operative lumbar discitis is rare, it’s associated with morbidity and mortality. The true challenge of post-operative discitis is to diagnose the condition timely. Majority of patients can be treated conservatively and operative management is rarely necessary in the patients with failed conservative treatment. Keywords: Lumbar discectomy, Postoperative pyogenic discitis, Literature review, Treatment

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One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis

Cited by 8 publications

References 22 publications

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

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

Combination Use of Antibiotic-Loaded Calcium Sulfate Beads in Spinal Surgery for Patients with Spondylodiscitis：A Clinical Retrospective Study

Post-Discectomy Pyogenic Lumbar Discitis: A Literature Review

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