J Korean Orthop Assoc.  2010 Jun;45(3):165-172. 10.4055/jkoa.2010.45.3.165.

Management of Lumbar Pyogenic Spondylitis with Posterior Decompression and Interbody Fusion Using Transpedicular Screws

• Cho BK
• Kim YM
• Kim DS
• Choi ES
• Shon HC
• Park KJ
• Park JK
• Bae SH

• KMID: 2185514
• DOI: http://doi.org/10.4055/jkoa.2010.45.3.165

Abstract

PURPOSE
The purpose of this study is to assess the efficacy of posterior decompression and interbody fusion with posterior instrumentation in treating lumbar pyogenic spondylitis. MATERIALS AND
METHODS
Twenty-one patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with posterior fixation were reviewed. Clinically infection control (CRP normalization time) and rehabilitation were investigated. And radiologically, timing of achievement of fusion and changes of sagittal alignment were investigated.
RESULTS
Infection was controlled successfully without any recurrence and breakage of instrument. Stable interbody fusion was achieved in all cases within 6 months. Postoperative interval to achieve normal CRP was 28.7 (10-64) days. Ambulation was started on 5.8th (2-19) day. Sagittal angle was 12.3 degrees before operation, became more lordotic to 16.4 degrees, but decreased to 11 degrees at final follow-up. Final sagittal alignment was almost same with the preoperative status.
CONCLUSION
By achieving favorable results clinically and radiologically, posterior decompression and interbody fusion seemed to be an effective method in management of lumbar pyogenic spondylitis.

Keyword

lumbar vertebrae; pyogenic spondylitis; posterior interbody fusion; transpedicular screw

MeSH Terms

Achievement
Decompression
Follow-Up Studies
Humans
Infection Control
Lumbar Vertebrae
Recurrence
Spondylitis
Walking

Figure

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  Figure 1 (A) The author's grading of destruction in the vertebral body was made according to the extent of destruction. The MRI images show grade I (B) and II (C) destruction of the body.

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  Figure 2 Mean sagittal angle of fixed segments at the last follow up showed difference of only 1.3 degrees compared to preoperative angle. Sagittal alignment of the infected segments showed similar pattern also.

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  Figure 3 (A) Preoperative radiographs reveal pyogenic spondylitis in L2-3. (B) Preoperative MRI shows grade II destruction of the body and epidural abscess in T2 weight sagittal image, right psoas abscess and involvement of posterior column in an axial image.

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  Figure 4 For patients with large dead space, we fixed another adjacent segment. We extended fixation to one level above and below. (A) Preoperative sagittal alignment of both fixed and infected segments was measured. (B) Sagittal alignment of both fixed and infected segments at the immediate postoperation was improved comparing to the preoperative angle. (C) Correction of the sagittal alignment was well maintained until the last follow up.

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