Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

Abstract

Purpose Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. Methods Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (KirkaldyWillis criteria). Results Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up. Conclusions Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine.It proved to be less invasive resulting in faster postoperative recovery.

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

“…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.…”

“…Posterior debridement requires more exposure to spinal tissues and structures; therefore, it is more traumatic and time consuming than anterior debridement. Gorensek et al . reported that the average blood loss during surgery and surgery time were 1150 mL and 207 min, respectively, using the single posterior approach for debridement and fusion of pyogenic osteomyelitis.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…Their results seem to support the views that a posterior approach alone is satisfactory, using a transforaminal lumbar interbody fusion to clear the disc, and do an interbody graft, then combined with pedicle fixation [33]. The paper by Gorensek et al [9] operated upon 23 of 108 patients, indicating that nonoperative treatment is most frequently most appropriate. Because neurological indications were frequent, in their series, decompression was necessary, and they achieved excellent results using a posterior approach alone, and the implantation of cages despite the presence of infection was not attended with failure.…”

“…In 2001 Stirling [6][7][8][9] using serological tests demonstrated [10] that culture of intervertebral disc material from 36 patients operated upon for severe sciatica, showed that 53 % grew Propionebacterium acnes. In the knowledge that Modic changes-bone oedema are present in only 6 % of the general population [11], but are present in 35 % of a back pain population, and the knowledge that these changes may be due to infection, Albert et al [12] asked the question whether nuclear tissue so infected led to such changes.…”

Treatment of infections of the lumbar spine with single-staged posterior instrumentation, disc debridement and interbody fusion with titanium cages

“…For this reason, it appeared sensate to extend the use of single-staged techniques to patients affected by spinal infections with minimal anterior column disruption. The combination of radical debridement and instrumentation through a single approach has, in fact, some theoretical advantages, such as reduction of blood loss, operative time and bed rest period (12,55,61,62). Von der Hoeh et al demonstrated that a single-stage operation is as effective as a 2-stage operation, but with shorter operative time and less blood loss, although a better reconstruction of the sagittal profile and less loss of reduction, not affecting the clinical outcome, was achieved in the two-stage posterior-anterior treated group (12).…”