J Korean Soc Spine Surg.  2016 Dec;23(4):216-222. 10.4184/jkss.2016.23.4.216.

Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis: Preliminary Report

• Kim YY
• Park C
• Rhyu KW

• KMID: 2365081
• DOI: http://doi.org/10.4184/jkss.2016.23.4.216

Abstract

STUDY DESIGN: Retrospective clinical study.
OBJECTIVES
To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. SUMMARY OF LITERATURE REVIEW: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders.
MATERIALS AND METHODS
Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups.
RESULTS
Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases.
CONCLUSIONS
The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.

Keyword

Lumbar; Pyogenic spondylodiscitis; Cortical bone trajectory pedicle screw; Posterior instrumentation

MeSH Terms

Clinical Study
Congenital Abnormalities
Debridement
Discitis*
Follow-Up Studies
Humans
Pedicle Screws*
Retrospective Studies
Transplants
Weights and Measures

Figure

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  Fig. 1. A 55 year old male patient (case No. 2). The initial plain roentgenograms from the initial period (A: AP, B: lateral) showed degenerative changes and severe ileus. The MRI showed signal changes for the L3 and L4 vertebral bodies with a huge paravertebral and epidural abscess (C: fat-suppressed T2-weighted sagittal image, D: T2-weighted axial image). Image (E) revealed the posterior extension of an infection through the right facet joint on the enhanced T2-weighted axial. The two-staged surgeries were done through L3-4 anterior interbody fusion and fixation of the posterior CBT pedicle screws (F: AP, G: lateral plain roentgenograms). After a 36 month follow-up period, plain film (H) showed a strong union and fixation of the operated area. A complete bony union is confirmed on the CT (I).

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