Treatment of Thoracolumbar Pyogenic Spondylitis with Minimally Invasive Posterior Fixation without Anterior Lesion Debridement or Bone Grafting: A Multicenter Case Study

Abstract

The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation alone were retrospectively evaluated at nine affiliated hospitals since April 2016. The study included 31 patients (23 men and 8 women; mean age, 73.3 years). The clinical course of the patients and requirement of additional anterior surgery constituted the study outcomes. The postoperative numerical rating scale score for lower back pain was significantly smaller than the preoperative score (5.8 vs. 3.6, p = 0.0055). The preoperative local kyphosis angle was 6.7°, which was corrected to 0.1° after surgery and 3.7° at the final follow-up visit. Owing to failed infection control, three patients (9.6%) required additional anterior debridement and autogenous bone grafting. Thus, in this multicenter case series, a large proportion of patients with thoracolumbar pyogenic spondylitis could be treated with minimally invasive posterior fixation alone, thereby indicating it as a treatment option for pyogenic spondylitis.

Pedicle screw insertion into infected vertebrae reduces operative time and range of fixation in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis: a multicenter retrospective cohort study

“…In various reports, the incidence of additional anterior surgery following inadequate infection control with isolated posterior fixation in the surgical treatment of pyogenic spondylitis is reported to range from 2–17%. [6, 9 , 16 , 23 – 24 The skip group had a higher proportion of patients with strong bone destruction of the infected vertebrae than the insertion group. Severe bone destruction of the infected vertebrae is a predictor of resistance to conservative treatment and the need for surgery [ 15 ].…”

“…For this, we retrospectively reviewed a consecutive series of 100 patients who underwent minimally invasive posterior fixation procedures, mainly using PPS, for thoracolumbar pyogenic spondylitis refractory to conservative therapy. Based on the methodology of previous studies, the patients across nine affiliated institutions were followed-up postoperatively for at least 6 months since January 2014 [ 9 , 14 ]. Cases in which planned anterior or posterior debridement, bone grafting, or similar procedures were performed, were excluded [ 9 ].…”

“…Based on the methodology of previous studies, the patients across nine affiliated institutions were followed-up postoperatively for at least 6 months since January 2014 [ 9 , 14 ]. Cases in which planned anterior or posterior debridement, bone grafting, or similar procedures were performed, were excluded [ 9 ].…”

Acute Lumbar Pyogenic Spondylitis With Multiple Abscesses Complicated by a Septic Shock That Required Emergency Surgical Open Drainage: A Case Report

“…Early surgical intervention is recommended for cases of pyogenic spondylitis that are resistant to conservative treatment or are complicated by severe bone destruction, neuropathy, or spinal instability [5][6][7]. Anemia, hypoalbuminemia, multiple intervertebral lesions, and epidural abscesses have been reported as factors associated with resistance to conservative treatment [8].…”

Two-Stage Cervical and Thoracic-Lumbar-Sacral Circumferential Fixation for Pyogenic Spondylitis: A Case Report

“…Anterior, posterior, or combined anterior and posterior open surgery is typically indicated for pyogenic spondylitis [ 7 ]. In addition to these conventional approaches, following technological advancements, minimally invasive surgery via the posterior approach using percutaneous pedicle screws (PPSs) has been reported to be safe and effective for pyogenic spondylitis and spondylodiscitis [ 8 , 9 ]. The effectiveness of oblique lumbar intervertebral fixation (OLIF) for thoracic and lumbar pyogenic spondylodiscitis has also been described [ 10 , 11 ].…”