Abstract
Introduction
The rate of hematogenous infections of the intervertebral disc is increasing as mostly elderly and immunocompromised patients are affected. Surgery is indicated if the disease is progressive with destruction of the local with instability and/or neurological impairment. Debridement of intervertebral abscess, decompression of the spinal canal, and stabilization of the segment is necessary. At the lumbar spine, the ventral approach allows a radical debridement of the abscess but is less suited for stabilization, especially, in cases with poor bone quality. Therefore, often a two-stage intervention with additional decompression and stabilization from posterior is performed. In this study, we report on the midterm to long-term outcome of a single stage strategy with debridement, cement-interposition, and stabilization from posterior for progressive, erosive spondylodiscitis.
Methods
In a retrospective, single center case series, patients were evaluated who were surgically treated for progressive, erosive spondylodiscitis. The single stage strategy consists of a lamino- and recessotomy for decompression, debridement of the disc space, and the affected bone through annulotomy, filling of the resulting defect with an antibiotic containing cement spacer and monosegmental to bisegmental stabilization with transpedicular screw fixation.
Results
From 1997 to 2012, 62 patients (34 males, 28 females, mean age 70 years [range, 32–92 years]) were treated with this technique. Overall, 54 patients were available for a minimal follow-up of 1 year (mean FU, 23.2 months; six died in the first year, two lost). Overall, two patients required additional debridement from ventral for persisting infection in all other the infection was treated successfully with the posterior intervention alone. Mean operation time was 164 (range, 120–347) minutes, blood loss 812 (range, 100–2,500) mL, length of hospital stay 11.7 (range, 2–42) days. Overall, 2 patients died during initial hospitalization, 12 patients during follow-up; in 4 cases, the cause of death was unknown in the other cases not related to the infection. Of the 14 patients, 8 with neurological impairment recovered completely. Three other patients needed a second intervention during the initial hospital stay (one hematoma, one revision of a dural tear, and one decompression for foraminal cement leakage). Nine patients required a secondary intervention of the spine during the first year (three implant loosening/failure, two adjacent segment disease, two spondylodiscitis with a different germ, and two persisting infection with debridement of the psoas abscess from anterior).
Conclusion
The single stage strategy with debridement, cement-interposition, and stabilization from posterior is a valid option for the treatment of progressive, erosive spondylodiscitis of the lumbar spine. The complication rate is relatively low and the rate of persisting infection with 3.2% comparable with the results of two-stage procedures.