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Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis

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Abstract

Background

Most adult patients with pyogenic lumbar or thoracic spondylodiscitis are treated with an external orthosis and antimicrobial therapy for several weeks to months. If surgical intervention is required, a combined anterior and posterior approach for debridement and fusion with autologous bone graft or titanium mesh cage is usually performed.

Method

We here report on our experience with the use of a minimally invasive percutaneous dorsal pedicle screw-rod spondylodesis in adult patients with pyogenic lumbar or thoracic spondylodiscitis.

Findings

Eight patients with lumbar, one with thoracolumbar and three with thoracic pyogenic spondylodiscitis with a mean back pain of 9/10 on the visual analog scale (VAS) and without corresponding neurological deficits were treated. Immediately after the operation, we calculated a significant reduction of the back pain on the VAS to 1.7, of leukocyte counts and C-reactive protein levels. After a mean of 61 days of continuous antimicrobial therapy during full mobilization, all patients were pain free, and leukocyte counts as well as C-reactive protein levels were normalized.

Conclusions

We conclude that minimally invasive percutaneous fixation is a feasible and effective technique to achieve immediate pain release, avoid long-term immobilization and overcome the disadvantages of a dorsoventral procedure. However, surgical complications and possible follow-up procedures supplement the patients' risks of adverse reactions of the disease.

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Correspondence to Martin H. Deininger.

Additional information

Comments

The choice between open debridement and excision of necrotic bone tissues or not, is related to the presence of large abcess or compression of neural elements. In this paper the parameters for this decision-making is well discussed

The decision reached to perform complementary posterior fixation is related to the degree of kyphotic deformity or the failure of pain control as an alternative of the required long-term external contention.

Gilles Perrin

Lyon, France

Comments

This is an interesting report on 12 cases with spondylodiscitis treated with posterior transpedicular fixation without fusion. Immediate mobility was gained after surgery and pain levels decreased impressively both directly after surgery and at f-up at about 3/4 of a year. Not adressing surgically the infected disc space is new in concept and one can say that such an isolated internal fixation can replace effectively and with limited risk the external bracing principle. however, potential complications of the procedure (screw misplacement, pseudarthrosis, hematoma) have to be weighed against external bracing.

Michael Payer

Geneva, Switzerland

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Deininger, M.H., Unfried, M.I., Vougioukas, V.I. et al. Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis. Acta Neurochir 151, 1451–1457 (2009). https://doi.org/10.1007/s00701-009-0377-3

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  • DOI: https://doi.org/10.1007/s00701-009-0377-3

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