Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Abstract

Purpose This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection. Methods Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed. Results Differences (p<0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45). Conclusions The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B.

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

“…Four studies compared anterior and/or posterior approaches [16,17,29,39]. The RCT of Linhardt et al and the PCoS of Si et al both compared a combined anterior and posterior stabilization with an isolated anterior spondylodesis [29,39].…”

“…The RCoS by Vcelak et al evaluated the differences between a combined anterior and posterior approach and an isolated posterior approach [17]. No statistically significant differences in reoperation rate, relapse, treatment failure, or mortality were found [17]. The isolated posterior approach group had a statistically significant greater loss of sagittal balance; however, this had no clinical consequences [17].…”

“…They both reported less pain and statistically significant better clinical outcomes (SF36, Oswestry, ODI, and VAS) in the anterior only group [29,39]. The RCoS by Vcelak et al evaluated the differences between a combined anterior and posterior approach and an isolated posterior approach [17]. No statistically significant differences in reoperation rate, relapse, treatment failure, or mortality were found [17].…”

“…This resulted in 25 included studies (Table 3). Ten studies containing only a minority of tuberculosis or postoperative infection cases (2.9-38 %) were included in the review [16][17][18][27][28][29][30][31][32][33]. At total of 75 patients in the current review had tuberculosis and 52 patients had a postoperative infection, which represented, respectively, 3.1 and 2.2 % of all included patients.…”

“…Classically anterior debridement and stabilization has been the preferred treatment, since the anterior part of the spine is the most commonly involved in spondylodiscitis [2]. In recent literature, however, both more elaborated combined anteriorposterior approaches, less invasive posterior stabilization, or transpedicular curettage and drainage have been described [16][17][18]. Whereas the open surgical procedures are thought to reduce the loss of sagittal balance and minimize the risk of relapse, less invasive strategies are a lower burden for the patients with potentially fewer complications [16,17].…”