Top

Acta Neurochirurgica

Published in:

01-06-2021 | Spondylodiscitis | Original Article - Infection

Minimally invasive posterior pedicle screw fixation versus open instrumentation in patients with thoracolumbar spondylodiscitis

Authors: Insa Katrin Janssen, Ann-Kathrin Jörger, Melanie Barz, Chiara Sarkar, Maria Wostrack, Bernhard Meyer

Published in: Acta Neurochirurgica | Issue 6/2021

Abstract

Background

Due to the aging society, the incidence of pyogenic spondylodiscitis is still rising. Although surgical treatment for spondylodiscitis in general is increasingly accepted, an optimal surgical strategy for treatment of pyogenic spinal infection has not yet been established. The aim of this study was to investigate the suitability of percutaneous posterior pedicle screw fixation for surgical treatment in patients with spondylodiscitis of the thoracolumbar spine.

Methods

We conducted a retrospective review of a consecutive cohort of patients undergoing surgical treatment for spondylodiscitis of the thoracolumbar spine between January 2017 and December 2019. We assessed intraoperative and clinical data, comparing for the classic open and the percutaneous approach. In total, we analyzed 125 cases (39 female, 86 male). The mean age was 69.49 years ± 12.63 years.

Results

Forty-seven (37.6%) patients were operated on by a percutaneous approach for pedicle screw fixation, and 78 (62.4%) received open surgery. There was no significant difference in the mean age of patients between both groups (p= 0.57). The time of surgery for percutaneous fixation was statistically significantly shorter (p= 0.03). Furthermore, the estimated intraoperative blood loss was significantly lower in the minimally invasive group (p < 0.001). No significant difference could be observed regarding the recurrence rate of spondylodiscitis and the occurrence of surgical site infections (p= 0.2 and 0.5, respectively).

Conclusion

Percutaneous posterior pedicle screw fixation appears to be a feasible option for the surgical treatment of a selected patient group with spondylodiscitis of the thoracic and lumbar spine.

Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K (2013) Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 3. https://doi.org/10.1136/bmjopen-2012-002412

Bernard L, Dinh A, Ghout I, Simo D, Zeller V, Issartel B, Le Moing V, Belmatoug N, Lesprit P, Bru JP, Therby A, Bouhour D, Denes E, Debard A, Chirouze C, Fevre K, Dupon M, Aegerter P, Mulleman D, Duration of rreatment for spondylodiscitis study g (2015) Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 385:875–882. https://doi.org/10.1016/S0140-6736(14)61233-2CrossRefPubMed

Cheung WY, Luk KD (2012) Pyogenic spondylitis. Int Orthop 36:397–404. https://doi.org/10.1007/s00264-011-1384-6CrossRefPubMed

Duan K, Qin Y, Ye J, Zhang W, Hu X, Zhou J, Gao L, Tang Y (2020) Percutaneous endoscopic debridement with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis: a preliminary study. Int Orthop 44:495–502. https://doi.org/10.1007/s00264-019-04456-1CrossRefPubMed

Farah K, Peyriere H, Graillon T, Prost S, Dufour H, Blondel B, Fuentes S (2020) Minimally invasive posterior fixation and anterior debridement-fusion for thoracolumbar spondylodiscitis: a 40-case series and review of the literature. Neurochirurgie 66:24–28. https://doi.org/10.1016/j.neuchi.2019.10.009CrossRefPubMed

Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976) 24:1023–1028. https://doi.org/10.1097/00007632-199905150-00017CrossRef

Gonzalvo A, Abdulla I, Riazi A, De La Harpe D (2011) Single-level/single-stage debridement and posterior instrumented fusion in the treatment of spontaneous pyogenic osteomyelitis/discitis: long-term functional outcome and health-related quality of life. J Spinal Disord Tech 24:110–115. https://doi.org/10.1097/BSD.0b013e3181dd8115CrossRefPubMed

Goodnough LT, Maggio P, Hadhazy E, Shieh L, Hernandez-Boussard T, Khari P, Shah N (2014) Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 54:2753–2759. https://doi.org/10.1111/trf.12723CrossRefPubMed

Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65(Suppl 3):iii11–iii24. https://doi.org/10.1093/jac/dkq303CrossRefPubMed

10.

Guerado E, Cervan AM (2012) Surgical treatment of spondylodiscitis. An update. Int Orthop 36:413–420. https://doi.org/10.1007/s00264-011-1441-1CrossRefPubMedPubMedCentral

11.

Kandwal P, Garg B, Upendra B, Chowdhury B, Jayaswal A (2012) Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop 46:159–164. https://doi.org/10.4103/0019-5413.93680CrossRefPubMedPubMedCentral

12.

Kato S, Chikuda H, Ohya J, Oichi T, Matsui H, Fushimi K, Takeshita K, Tanaka S, Yasunaga H (2016) Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score matched analysis. Spine J 16:55–60. https://doi.org/10.1016/j.spinee.2015.10.014CrossRefPubMed

13.

Lee BH, Park JO, Kim HS, Lee HM, Cho BW, Moon SH (2014) Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis. Indian J Orthop 48:74–80. https://doi.org/10.4103/0019-5413.125508CrossRefPubMedPubMedCentral

14.

Lin TY, Tsai TT, Lu ML, Niu CC, Hsieh MK, Fu TS, Lai PL, Chen LH, Chen WJ (2014) Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 15:443. https://doi.org/10.1186/1471-2474-15-443CrossRefPubMedPubMedCentral

15.

Mikhail C, Pennington Z, Arnold PM, Brodke DS, Chapman JR, Chutkan N, Daubs MD, DeVine JG, Fehlings MG, Gelb DE, Ghobrial GM, Harrop JS, Hoelscher C, Jiang F, Knightly JJ, Kwon BK, Mroz TE, Nassr A, Riew KD, Sekhon LH, Smith JS, Traynelis VC, Wang JC, Weber MH, Wilson JR, Witiw CD, Sciubba DM, Cho SK (2020) Minimizing blood loss in spine surgery. Global Spine J 10:71S–83S. https://doi.org/10.1177/2192568219868475CrossRefPubMedPubMedCentral

16.

Mobbs RJ, Sivabalan P, Li J (2011) Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 18:741–749. https://doi.org/10.1016/j.jocn.2010.09.019CrossRefPubMed

17.

Pee YH, Park JD, Choi YG, Lee SH (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8:405–412. https://doi.org/10.3171/SPI/2008/8/5/405CrossRefPubMed

18.

Rutges JP, Kempen DH, van Dijk M, Oner FC (2016) Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 25:983–999. https://doi.org/10.1007/s00586-015-4318-yCrossRefPubMed

19.

Shiban E, Janssen I, Wostrack M, Krieg SM, Ringel F, Meyer B, Stoffel M (2014) A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience. Acta Neurochir (Wien) 156:1189–1196. https://doi.org/10.1007/s00701-014-2058-0CrossRef

20.

Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, Kanj SS (2010) Pyogenic spondylodiscitis: an overview. J Infect Public Health 3:5–16. https://doi.org/10.1016/j.jiph.2010.01.001CrossRefPubMed

21.

Styf JR, Willen J (1998) The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976) 23:354–358. https://doi.org/10.1097/00007632-199802010-00014CrossRef

22.

Vcelak J, Chomiak J, Toth L (2014) Surgical treatment of lumbar spondylodiscitis: a comparison of two methods. Int Orthop 38:1425–1434. https://doi.org/10.1007/s00264-014-2360-8CrossRefPubMedPubMedCentral

23.

Wang Y, Shi X, Wen M, Chen Y, Zhang Q (2017) Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis. Curr Med Res Opin 33:761–768. https://doi.org/10.1080/03007995.2017.1280010CrossRefPubMed

24.

Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS (2018) Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6:104. https://doi.org/10.21037/atm.2018.03.24CrossRefPubMedPubMedCentral

25.

Zarghooni K, Rollinghoff M, Sobottke R, Eysel P (2012) Treatment of spondylodiscitis. Int Orthop 36:405–411. https://doi.org/10.1007/s00264-011-1425-1CrossRefPubMed

Title: Minimally invasive posterior pedicle screw fixation versus open instrumentation in patients with thoracolumbar spondylodiscitis
Authors: Insa Katrin Janssen
Ann-Kathrin Jörger
Melanie Barz
Chiara Sarkar
Maria Wostrack
Bernhard Meyer
Publication date: 01-06-2021
Publisher: Springer Vienna
Keyword: Spondylodiscitis
Published in: Acta Neurochirurgica / Issue 6/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04744-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Minimally invasive posterior pedicle screw fixation versus open instrumentation in patients with thoracolumbar spondylodiscitis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2021

Letter to the Editor regarding “Chiari I malformation and pregnancy: a comprehensive review of the literature to address common questions and to guide management.”

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

Correction to: on the need of creating multicenter registries for more suitable matched cohort studies to elucidate best multidisciplinary care strategies for patients with Chiari malformations

Selection of treatment strategies for recurrent glossopharyngeal neuralgia after MVD

Research activity amongst DCM research priorities

Tear-drop technique in iliac screw placement: a technical analysis