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Single-stage anterior debridement and fusion with autografting and internal fixation for pyogenic lumbar spondylodiscitis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Patients with pyogenic lumbar spondylodiscitis can be successfully treated by non-operative methods. However, the typical operation for this condition includes debridement of the infected site, bone grafting and internal fixation to stabilize the spine. Single-stage anterior debridement and fusion with autografting and internal fixation of one spinal segment were performed on nine patients with pyogenic lumbar spondylodiscitis. This operative procedure is rarely documented for pyogenic lumbar spondylodiscitis.

Aim

To evaluate the safety and effectiveness of single-stage anterior debridement, autografting and internal fixation of one spinal segment for pyogenic lumbar spondylodiscitis.

Results

At the final follow-up, seven out of the nine patients were pain free. Two patients had mild, intermittent back pain (Visual Analogue Scale rating of 1–2), which represented an improvement from their preoperative pain. All nine patients had no clinical, laboratory or radiological evidence of recurrence of infection. Moreover, all the patients showed solid bony fusion.

Conclusion

Based on the limited population studied, it suggested that this technique may be a safe and effective operative procedure for appropriate pyogenic lumbar spondylodiscitis in patients.

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References

  1. Klöckner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous. Spondylodiscitis 28(10):1036–1042

    Google Scholar 

  2. Asamoto S, Doi H, Kobayashi N et al (2005) Spondylodiscitis: diagnosis and treatment. Surg Neurol 64(2):103–108

    Article  PubMed  Google Scholar 

  3. Bettini N, Girardo M, Dema E et al (2009) Evaluation of conservative treatment of non specific spondylodiscitis. Eur Spine J 18(Suppl 1):S143–S150

    Article  Google Scholar 

  4. Butler JS, Shelly MJ, Timlin M et al (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 31(23):2695–2700

    Article  Google Scholar 

  5. Cahill DW, Love LC, Rechtine GR (1991) Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg 74(6):878–886

    Article  PubMed  CAS  Google Scholar 

  6. Cheung WY, Luk KD (2011) Pyogenic spondylitis. Int Orthop [Epub ahead of print]

  7. D’Agostino C, Scorzolini L, Massetti AP et al (2010) A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection 38(2):102–107

    Article  PubMed  Google Scholar 

  8. Dai LY, Chen WH, Jiang LS (2008) Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J 17(8):1027–1034

    Article  PubMed  Google Scholar 

  9. Dimar JR, Carreon LY, Glassman SD et al (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29(3):326–332

    Article  Google Scholar 

  10. Fang D, Cheung KM, Dos RI et al (1994) Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion. J Spinal Disord 7(2):173–180

    Article  PubMed  CAS  Google Scholar 

  11. Fukuta S, Miyamoto K, Masuda T et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976) 28(15):E302–E308

    Google Scholar 

  12. Gonzalvo A, Abdulla I, Riazi A et al (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(2):110–115

    Article  PubMed  Google Scholar 

  13. Ha KY, Shin JH, Kim KW et al (2007) The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis. Spine (Phila Pa 1976) 32(17):1856–1864

    Article  Google Scholar 

  14. Hee HT, Majd ME, Holt RT et al (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156

    Article  PubMed  Google Scholar 

  15. Helewa RM, Embil JM, Boughen CG et al (2008) Risk factors for infectious spondylodiscitis in patients receiving hemodialysis. Infect Control Hosp Epidemiol 29(6):567–571

    Article  PubMed  Google Scholar 

  16. Hoelscher GL, Gruber HE, Coldham G et al (2000) Effects of very high antibiotic concentrations on human intervertebral disc cell proliferation, viability, and metabolism in vitro. Spine (Phila Pa 1976) 25(15):1871–1877

    Article  CAS  Google Scholar 

  17. Kim CJ, Song KH, Jeon JH et al (2010) A comparative study of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976) 35(21):E1096–E1100

    Article  Google Scholar 

  18. Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 88(6):765–770

    Article  PubMed  CAS  Google Scholar 

  19. Liljenqvist U, Lerner T, Bullmann V et al (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12(6):606–612

    Article  PubMed  CAS  Google Scholar 

  20. Mori S, Tomita Y, Horikawa T et al (2008) Delayed spinal infection after laminectomy in a patient with rheumatoid arthritis interruptedly exposed to anti-tumor necrosis factor alpha agents. Clin Rheumatol 27(7):937–939

    Article  PubMed  Google Scholar 

  21. Nakase H, Matsuda R, Tamaki R et al (2006) Two-stage management for vertebral osteomyelitis and epidural abscess: technical note. Neurosurgery 58(6):1219

    Article  Google Scholar 

  22. Rath SA, Neff U, Schneider O et al (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38(5):926–933

    Article  PubMed  CAS  Google Scholar 

  23. Robinson Y, Tschoeke SK, Finke T et al (2008) Successful treatment of spondylodiscitis using titanium cages: a 3-year follow-up of 22 consecutive patients. Acta Orthop 79(5):660–664

    Article  PubMed  Google Scholar 

  24. Sundararaj GD, Babu N, Amritanand R et al (2007) Treatment of haematogenous pyogenic vertebral osteomyelitis by single-stage anterior debridement, grafting of the defect and posterior instrumentation. J Bone Joint Surg Br 89(9):1201–1205

    Article  PubMed  CAS  Google Scholar 

  25. Tali ET (2004) Spinal infections. Eur J Radiol 50(2):120–133

    Article  PubMed  Google Scholar 

  26. Turunc T, Demiroglu YZ, Uncu H et al (2007) A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55(2):158–163

    Article  PubMed  Google Scholar 

  27. Tyler KL (2008) Acute pyogenic diskitis (spondylodiskitis) in adults. Rev Neurol Dis 5(1):8–13

    PubMed  Google Scholar 

  28. Walters R, Moore R, Fraser R (2006) Penetration of cephazolin in human lumbar intervertebral disc. Spine 31(5):567–570

    Article  PubMed  Google Scholar 

  29. Wirtz DC, Genius I, Wildberger JE et al (2000) Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis—an evaluation of 59 cases. Arch Orthop Trauma Surg 120(5–6):245–251

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Medical School of Zhejiang University, 79 Qingchun Road, Hangzhou, China

    Xiang Wang

  2. Department of Orthopaedic Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 ChangHuai Road, Bengbu, Anhui, China

    Jianshen Zhou, Changchun Zhang & Zhenhua Liu

Authors
  1. Xiang Wang
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  2. Jianshen Zhou
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  3. Changchun Zhang
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  4. Zhenhua Liu
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Correspondence to Zhenhua Liu.

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Wang, X., Zhou, J., Zhang, C. et al. Single-stage anterior debridement and fusion with autografting and internal fixation for pyogenic lumbar spondylodiscitis. Arch Orthop Trauma Surg 132, 487–493 (2012). https://doi.org/10.1007/s00402-011-1451-x

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  • DOI: https://doi.org/10.1007/s00402-011-1451-x

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