Skip to main content
Log in

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Spondylodiscitis mainly affects the anterior part of the spine. In this paper, we retrospectively analyze our experience with the anterior stand-alone approach (ASAA) in the treatment of spinal infections.

Methods

Forty consecutive patients with severe spondylodiscitis underwent the ASAA during the acute infective phase. Treatment consisted of disease debridement, vertebral body reconstruction using titanium expandable prostheses and anterior fixation.

Results

There was neither mortality nor major morbidity. Successful arthrodesis was achieved in 39 out of 40 patients who remained disease free throughout the follow-up period. Six months after treatment, one patient experienced pseudarthrosis and required supplemented posterior spinal fixation for vertebral instability. However, adequate arthrodesis was eventually obtained even in this patient.

Conclusions

ASAA with spine reconstruction using synthetic materials during the acute infection phase was safe and effective. The infections were rapidly defeated, the patients were allowed to stand up early after the procedure and the length of hospital stay was significantly reduced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hodgson AR, Stock FE, Fang HS, Ong GB (1960) Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178

    Article  PubMed  CAS  Google Scholar 

  2. Krodel A, Sturz H (1989) Differentiated surgical and conservative treatment of spondylitis and spondylodiscitis. Z Orthop Ihre Grenzbeg 127:587–596 in German

    Article  CAS  Google Scholar 

  3. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA (1983) Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am 65:19–29

    PubMed  CAS  Google Scholar 

  4. Calderone RR, Larsen JM (1996) Overview and classification of spinal infections. Orthop Clin North Am 27:1–8

    PubMed  CAS  Google Scholar 

  5. D’Aliberti G, Talamonti G, Villa F, Debernardi A, Sansalone CV, LaMaida A, Torre M, Collice M (2008) Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases. J Neurosurg Spine 9:466–482

    Article  PubMed  Google Scholar 

  6. Chang CC, Merritt K (1994) Infection at the site of implanted materials with and without preadhered bacteria. J Orthop Res 12:526–531

    Article  PubMed  CAS  Google Scholar 

  7. American Spinal Cord Injury Association (1992) Standards for neurological and functional classification of spinal cord injury, revised. Americal Spinal Cord Injury Association, Chicago

    Google Scholar 

  8. Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:142–149

    PubMed  Google Scholar 

  9. Kim KD, Johnson PJ, Masciopinto JE (1999) Management of spinal epidural abscess and subdural empyema. Tech Neurosurg 5:293–302

    Article  Google Scholar 

  10. McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34:1342–1350

    Article  PubMed  Google Scholar 

  11. Hsieh P, Wienecke RJ, O’Shaughnessy BA, Koski TR, Ondra SL (2004) Surgical strategies for vertebral osteomyelitis and epidural abscess. Neurosurg Focus 17:E4

    Article  PubMed  Google Scholar 

  12. Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24:8–13

    Article  PubMed  CAS  Google Scholar 

  13. Ruf M, Strolze D, Merck RH, Ames M, Harms J (2007) Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cage. Spine 32:E275–E280

    Article  PubMed  Google Scholar 

  14. Kuklo TR, Potter BK, Bell SB, Moquin RR, Rosner MK (2006) Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 19:376–382

    Article  PubMed  Google Scholar 

  15. Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V (2003) Role of posterior stabilization in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br 85:100–106

    Article  PubMed  CAS  Google Scholar 

  16. Yilmaz C, Selek HY, Gurkan I, Erdemli B, Korkusuz Z (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81:1261–1267

    PubMed  CAS  Google Scholar 

  17. Dvorak MF, Known BK, Fisher CG, Eiserloh HL, Boyd M, Wing PC (2003) Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine 28:902–908

    PubMed  Google Scholar 

  18. Grob D, Daehn S, Mannion AF (2005) Titanium mesh cages (TMC) in spine surgery. Eur Spine J 14:211–221

    Article  PubMed  Google Scholar 

  19. Ecklund JM, Depper MH, Zeidman SM (1999) Pyogenic vertebral osteomyelitis. Tech Neurosurg 5:282–292

    Article  Google Scholar 

  20. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916

    Article  PubMed  CAS  Google Scholar 

  21. Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14:284–291

    PubMed  CAS  Google Scholar 

  22. Krodel A, Kruger A, Lohscheidt K, Pfahler M, Reflor HJ (1999) Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26

    PubMed  CAS  Google Scholar 

  23. Klockner 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. Spine 28:1036–1042

    PubMed  Google Scholar 

  24. Safran O, Rand N, Kaplan L, Sagiv S, Floman Y (1998) Sequential or simultaneous, same-day anterior decompression and posterior stabilization in the management of vertebral osteomyelitis of the lumbar spine. Spine 23:1885–1890

    Article  PubMed  CAS  Google Scholar 

  25. McDonnel DE, Harrison SJ (1998) Lateral approach to the craniocervical complex. Tech Neurosurg 4:306–318

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giuseppe Talamonti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

D’Aliberti, G., Talamonti, G., Villa, F. et al. The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients. Eur Spine J 21 (Suppl 1), 75–82 (2012). https://doi.org/10.1007/s00586-012-2238-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2238-7

Keywords

Navigation