Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis.

Abstract

BACKGROUND:

Most adult patients with pyogenic lumbar or thoracic spondylodiscitis are treated with an external orthosis and antimicrobial therapy for several weeks to months. If surgical intervention is required, a combined anterior and posterior approach for debridement and fusion with autologous bone graft or titanium mesh cage is usually performed.

METHOD:

We here report on our experience with the use of a minimally invasive percutaneous dorsal pedicle screw-rod spondylodesis in adult patients with pyogenic lumbar or thoracic spondylodiscitis.

FINDINGS:

Eight patients with lumbar, one with thoracolumbar and three with thoracic pyogenic spondylodiscitis with a mean back pain of 9/10 on the visual analog scale (VAS) and without corresponding neurological deficits were treated. Immediately after the operation, we calculated a significant reduction of the back pain on the VAS to 1.7, of leukocyte counts and C-reactive protein levels. After a mean of 61 days of continuous antimicrobial therapy during full mobilization, all patients were pain free, and leukocyte counts as well as C-reactive protein levels were normalized.

CONCLUSIONS:

We conclude that minimally invasive percutaneous fixation is a feasible and effective technique to achieve immediate pain release, avoid long-term immobilization and overcome the disadvantages of a dorsoventral procedure. However, surgical complications and possible follow-up procedures supplement the patients' risks of adverse reactions of the disease.

• Authors: Martin H Deininger, Miriam I Unfried, Vassilios I Vougioukas, Ulrich Hubbe
• Journal: Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 151 Issue 11 Pg. 1451-7 (Nov 2009) ISSN: 0942-0940 [Electronic] Austria
• PMID: 19468676 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Age Factors
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bed Rest (adverse effects)
• Bone Screws
• Discitis (drug therapy, microbiology, surgery)
• Female
• Humans
• Immobilization (adverse effects)
• Internal Fixators
• Low Back Pain (drug therapy, microbiology, surgery)
• Lumbar Vertebrae (diagnostic imaging, pathology, surgery)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (instrumentation, methods)
• Osteomyelitis (diagnosis, drug therapy, surgery)
• Pain Measurement
• Postoperative Complications (etiology, prevention & control)
• Spinal Fusion (instrumentation, methods)
• Thoracic Vertebrae (diagnostic imaging, pathology, surgery)
• Tomography, X-Ray Computed
• Treatment Outcome