J Korean Neurosurg Soc.  2014 Oct;56(4):310-314. 10.3340/jkns.2014.56.4.310.

Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis

• Kim SH
• Kang MS
• Chin DK
• Kim KS
• Cho YE
• Kuh SU

• KMID: 2018081
• DOI: http://doi.org/10.3340/jkns.2014.56.4.310

Abstract

OBJECTIVE
To analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis.
METHODS
A total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF.
RESULTS
All of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8+/-1.1, which improved to 3.2+/-2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0+/-14.8, which improved to 34.2+/-27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic.
CONCLUSION
Our results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis.

Keyword

Anterior lumbar interbody fusion; Postoperative spondylodiscitis

MeSH Terms

Anti-Bacterial Agents
Blood Sedimentation
C-Reactive Protein
Discitis*
Humans
Leg
Male
Spine
Anti-Bacterial Agents
C-Reactive Protein

Figure

• 

  Fig. 1 A 36-year-old man with psoas muscle abscess. One month previously, he had undergone total disc replacement at L4-5 at another hospital. One month after the surgery, he was referred to our hospital for new-onset back pain and fever. A : The initial X-ray. B : Pre-contrast T1-weighted sagittal. C : T2-weighted sagittal. D : Post-contrast T1-weighted sagittal MRI scan showed bony destruction of L4 and L5 vertebral bodies. E : post-contrast T1-weighted axial MRI scan showed extensive paravertebral and psoas abscess (arrow). He underwent debridement of the infected tissue along with ALIF using an autologous tricortical iliac bone graft. F : The follow-up X-ray showed successful bony fusion and appropriate sagittal alignment.

Reference

1. Boden SD, Sumner DR. Biologic factors affecting spinal fusion and bone regeneration. Spine (Phila Pa 1976). 1995; 20(24 Suppl):102S–112S. PMID: 8747264.

2. Camp JF, Caudle R, Ashmun RD, Roach J. Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study. Spine (Phila Pa 1976). 1990; 15:932–941. PMID: 2259984.

3. Choi JY, Choi YW, Sung KH. Anterior lumbar interbody fusion in patients with a previous discectomy : minimum 2-year follow-up. J Spinal Disord Tech. 2005; 18:347–352. PMID: 16021016.

4. Dufour V, Feydy A, Rillardon L, Redondo A, Le Page L, Bert F, et al. Comparative study of postoperative and spontaneous pyogenic spondylodiscitis. Semin Arthritis Rheum. 2005; 34:766–771. PMID: 15846593.

5. Duggal N, Mendiondo I, Pares HR, Jhawar BS, Das K, Kenny KJ, et al. Anterior lumbar interbody fusion for treatment of failed back surgery syndrome : an outcome analysis. Neurosurgery. 2004; 54:636–643. discussion 643-644. PMID: 15028138.

6. Emery SE, Chan DP, Woodward HR. Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine (Phila Pa 1976). 1989; 14:284–291. PMID: 2652335.

7. Houten JK, Post NH, Dryer JW, Errico TJ. Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus. 2006; 20:E8. PMID: 16599424.

8. Kemp HB, Jackson JW, Jeremiah JD, Hall AJ. Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg Br. 1973; 55:698–714. PMID: 4766176.

9. Kirkaldy-Willis WH, Thomas TG. Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. J Bone Joint Surg Am. 1965; 47:87–110. PMID: 14256976.

10. Liebergall M, Chaimsky G, Lowe J, Robin GC, Floman Y. Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment. Clin Orthop Relat Res. 1991; (269):142–150. PMID: 1864031.

11. Lim JK, Kim SM, Jo DJ, Lee TO. Anterior interbody grafting and instrumentation for advanced spondylodiscitis. J Korean Neurosurg Soc. 2008; 43:5–10. PMID: 19096537.

12. Quiñones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR. General principles in the medical and surgical management of spinal infections : a multidisciplinary approach. Neurosurg Focus. 2004; 17:E1. PMID: 15636566.

13. Schlegel KF, Pon A. The biomechanics of posterior lumbar interbody fusion (PLIF) in spondylolisthesis. Clin Orthop Relat Res. 1985; (193):115–119. PMID: 3971610.

14. Than KD, Wang AC, Rahman SU, Wilson TJ, Valdivia JM, Park P, et al. Complication avoidance and management in anterior lumbar interbody fusion. Neurosurg Focus. 2011; 31:E6. PMID: 21961869.

15. Vishteh AG, Dickman CA. Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation. Neurosurgery. 2001; 48:334–337. discussion 338. PMID: 11220376.