2022 Volume 13 Issue 1 Pages 20-28
Introduction: In our institute, the first choice of treatment for pyogenic spondylodiscitis in the thoracic and lumbar spine is anterior debridement and bone grafting with posterior spinal instrumentation. The purpose of this study was to evaluate the clinical outcomes of this method.
Methods: We included 16 patients (12 men, 6 women, mean age 69 years) who were treated with this procedure in our institute between April 2015-March 2020. The average follow-up time was 35 months (12-60 months). The affected level was T5/6 to L5/S. The most common comorbidity was diabetes mellitus which were seen in 10 cases. Patients with moderate bony destruction and severe unrelenting back pain or leg pain were indicated for surgery. We performed radical debridement of the infected tissue until good bleeding was seen from the grafting bed and autologous iliac bone grafting was done. Percutaneous pedicle screw system was mainly used for posterior instrumentation. Preoperative patient background factors, such as C-reactive protein (CRP) levels and causative organisms, and surgery-related factors such as the use of affected vertebral screws and reconstructive procedures were reviewed. Also, clinical outcomes were investigated using VAS scale, the Disability Independence Criteria for the Japanese Elderly, infection healing, and bone fusion rate. Statistical analysis was performed and P < 0.05 was considered significant.
Results: Reconstructive surgery was performed on an average of 22 days after hospitalization. Preoperative CRP was 2.9 mg/dl, which was significantly lower than that on admission (P < 0.001). The causative organism was identified in 15 patients (94%). In 12 cases, anterior debridement and reconstruction was done first, which was the most frequent pattern of surgery. VAS scale and the patient's ADL improved significantly postoperation (P < 0.001), and 13 patients (81%) were ambulatory at final follow-up. Infection healed in all patients and bony fusion was achieved in 15 patients (94%). In 13 cases (81%), pedicle screws were inserted in the affected vertebra, without any problems. The number of posterior fixed levels was significantly lower in patients with the pedicle screws inserted in the affected vertebra compared to those without the screws in the affected vertebra (P < 0.001).
Conclusions: This surgical procedure can be useful in patients with pyogenic spondylodiscitis resistant to conservative treatment in the thoracic and lumbar spine.
