J Korean Soc Spine Surg.  2010 Mar;17(1):18-25. 10.4184/jkss.2010.17.1.18.

One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

• Na HY
• Lee YS
• Choi JC
• Kim WS
• Song WS
• Noh HM
• Kim SJ
• Kim WS

• KMID: 2003095
• DOI: http://doi.org/10.4184/jkss.2010.17.1.18

Abstract

STUDY DESIGN: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis.
OBJECTIVES
To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. SUMMARY OF LITERATURE REVIEW: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach.
MATERIALS AND METHODS
Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings.
RESULTS
The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9degrees.
CONCLUSION
One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.

Keyword

Lumbar spine; Spondylodiscitis; Posterior interbody fusion; Instrumentation

MeSH Terms

Anti-Bacterial Agents
Debridement*
Discitis*
Follow-Up Studies
Hospitalization
Humans
Retrospective Studies
Transplants
Anti-Bacterial Agents

Figure

• 

  Fig. 1. A 50-year-old male with L2-3 pyogenic spondylodiscitis (S. aureus). (A) Preoperative lateral plain radiograph shows destructive change and space narrowing in lumbar 2, 3 vertebrae. (B) T2-weighted MR image, (C) T1-weighted MR image, (D) Contrast-enhanced fat suppression MR image shows end plate destruction and epidural abscess. (E) Contrast-enhanced T1-weighted axial MR image demonstrating epidural abscess and left psoas abscess (F) Lateral radiograph after operation shows posterior debridement, bone graft and posterior instrumentation with infected body. (G) Lateral radiograph obtained 1 year after operation shows bony fusion.

• 

  Fig. 2. A 47year-old man with L5-S1 pyogenic spondylitis. (A) Preoperative lateral plain radiograph shows destructive change, disc space narrowing in L5-S1 vertebrae. (B) T2 weighted MR image, (C) Contrast-enhanced T1-Weghted MR image (D) Fat suppression MR image demonstrating end plate destruction and epidural abscess. (E, F) Contrast-enhanced T1-weighted axial MR image showing inflammatory change and epidural abscess, (G) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation at infected vertebral body. (H) Lateral radiograph obtained 5 years after operation shows bony fusion.

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  Fig. 3. A 59-year-old female who had DM, HTN, and ESRD with L45 pyogenic spondylitis. (A) Initial lateral plain radiograph shows destructive change, disc space narrowing in L4-5 vertebra. (B) T2-weighted saggital MR image. (C) Contrast-enhanced T1-weighted MR image. (D) T1-weighted axial MR image. (E) T2-weighted axial MR image demonstrating epidural abscess and both psoas abscess. (F) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation (G) The 6-months later, lateral plain radiograph shows the progression of pyogenic spondylitis. More desctuctive vertebral body with L4 retrolisthesis.

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