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Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?

Results of a comparative study

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Abstract

The operative results of 23 patients with a specific or unspecific spondylodiscitis were documented over 2 years after the focus of the inflammation had been eradicated, bone chip had been interposed and a CDH instrumentation had been performed by an anterior approach only. These outcomes were compared with the results of 32 patients in whom the focus had been removed and the defect had been filled with bone graft from an anterior approach, followed by stabilisation with CD instrumentation through an additional dorsal approach. In the cases where CDH instrumentation was applied, the range of fusion averaged 1.3 segments. This was clearly less extensive than in dorsoventral stabilisation, in which on average 3.5 segments were fused. In 47 of 55 cases mobilisation was achieved without orthesis. Eight months after the operations bony fusion could be observed radiologically in all patients. The mean preoperative kyphotic angle of the affected segments was 14.4°, compared to 4° after the operation. The mean loss of reposition was measured to be about 2.7° in both groups. Average operation time and blood loss were about 50% higher in the patients treated dorsoventrally. We conclude that even in the case of florid spondylodiscitis, a short-range anterior fusion of the affected spinal segment may be performed by use of a stable-angle implant without an increased risk of infection-related loosening.

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References

  1. Aliabadi H, Johnson C, Cass AS, Mayfild J, Vandenbrink K (1984) Ureteral obstruction following the Dwyer procedure in a patient with an ileal loop urinary diversion. Spine 9: 819–821

    Google Scholar 

  2. Brown LP, Bridwell KH, Holt RT, Jennings J (1986) Aortic erosion and laceration associated with the Dunn anterior spinal instrumentation. Orthop Trans 10: 16–17

    Google Scholar 

  3. Brussatis F, Blümlein H, Wunderlich T (1983) Ergebnisse nach Ausräumung and ventraler Fusion bei Spondylitiden. Z Orthop Ihre Grenzgeb 121: 458–459

    Google Scholar 

  4. Buchner H, Pink P (1981) Die Spondylitis tuberculosa. Orthopdde 10: 119–132

    Google Scholar 

  5. Chan FL, Chow SP (1983) Retroperitoneal fibrosis after anterior spinal fusion. Clin Radiol 34:331–335

    Google Scholar 

  6. Cleveland RH, Gilsanz V, Lebowitz RL, Wilkinson RH (1978) Hydronephrosis from retroperitoneal fibrosis after anterior spine fusion: J Bone Joint Surg Am 60: 996–997

    Google Scholar 

  7. Collert S (1977) Osteomyelitis of the spine. Acta Orthop Scand 48: 283–290

    Google Scholar 

  8. Colton CL, Hall AJ (1991) Atlas of orthopaedic surgical approaches. Butterworth Heinemann, Stonehem

    Google Scholar 

  9. Costerton JW, Irvin RT, Cheng KJ (1981) The bacterial glycocalyx in nature and disease. Ann Rev Microbiol 35:299–324

    Google Scholar 

  10. Dick W, Graf R, Morscher E (1984) Konservative and operative Therapie der Spondylitis. Therapiewoche 34: 448–452

    Google Scholar 

  11. Digby JM, Kersley JB (1979) Pyogenic non-tuberculoss spinal infection. J Bone Joint Surg Br 61: 47–55

    Google Scholar 

  12. Dufek P, von Salis-Soglio G, Bozdech Z (1987) Die unspezifische bakterielle Spondylitis – eine Analyse von 32 Fallen. Z Orthop Ihre Grenzgeb 125: 225–261

    Google Scholar 

  13. Dunn HK (1984) Anterior stabilisation of thoracolumbar injuries. Clin Orthop 189:116–124

    Google Scholar 

  14. Dunn HK (1986) Anterior spine stabilization and decompression for thoracolumbar injuries. Orthop Clin North Am 17: 113–119

    Google Scholar 

  15. Dunn HK, Daniels AU, McBride GG (1980) Comparative assessment of spine stability achieved with a new anterior spine fixation system. Orthop Trans 4: 268–269

    Google Scholar 

  16. Dunn HK, Globe EM, McBride GG, Daniels AU (1981) An implant system for anterior spine stabilization. Orthop Trans 5: 433–434

    Google Scholar 

  17. Dwyer AF, Yau AC, Hsu L, O'Brien JP, Hodgson AR (1976) Deep paravertebral infection following Dwyer anterior spinal instrumentation. A report of three cases. Spine 1: 201–206

    Google Scholar 

  18. Eichenauer M, van der Lan EO, Mostegl A (1987) Vorwiegend ambulant-konservative Behandlung der unkomplizierten Spondylitis tuberculosa. Therapiewoche 37:122–131

    Google Scholar 

  19. 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

    Google Scholar 

  20. Enderle A, Schmitt E, Zichner L (1981) Zur Diagnostik herdförmiger Wirbelsdulenerkrankungen — eine kritische Betrachtung. Z Orthop Ihre Grenzgeb 119:193–205

    Google Scholar 

  21. Eysel P, Hopf C, Diop A, Lavaste F (1995) Die mehr-segmentale ventrale Stabilisierung der Lendenwirbelsäule: eine vergleichende biomechanische Studie. Z Orthop Ihre Grenzgeb 133: 242–248

    Google Scholar 

  22. Flynn JC, Price CT (1984) Sexual complications of anterior fusion of the lumbar spine. Spine 9: 489–492

    Google Scholar 

  23. Giehl JP, Zielke K, Hack HP (1989) Die ventrale Derotationsspondylodese nach Zielke. Orthopäde 18: 101–117

    Google Scholar 

  24. Gristina AG, Costerton JW (1985) Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 15: 517–535

    Google Scholar 

  25. Gristina AG, Oga M, Webb LX, Hobgood DC (1985) Bacterial adherence and the pathogenesis of osteomyelitis. Science 228: 990–993

    Google Scholar 

  26. Harmon PH (1964) A simplified surgical technique for anterior lumbar discectomy and fusion. Avoidance of complications. Anatomy of the retroperitoneal veins. Clin Orthop 37: 130–144

    Google Scholar 

  27. Heine J, Immenkamp M, Matthiass HH (1983) Ergebnisse der operativen Behandlung der Spondylitis tuberculosa. Z Orthop Ihre Grenzgeb 121: 457–461

    Google Scholar 

  28. Hodgson AR, Stock FE (1960) Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg [Am] 42: 295–310

    Google Scholar 

  29. Hopf C, Eysel P, Dubousset J (1995) CDH: preliminary report on a new anterior spinal instrumentation. Eur Spine J 4: 194–199

    Google Scholar 

  30. Ito H, Tsuchiy J, Asami G (1934) A new radical operation for potts disease. J Bone Joint Surg [Am] 16: 499–511

    Google Scholar 

  31. Jäger M, Springer HH (1981) Die entzündlichen Erkrankungen der Wirbelsäule. Orthopäde 10: 106–113

    Google Scholar 

  32. Jendrisak MD (1986) Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device. A case report. Surgery 99: 631–633

    Google Scholar 

  33. Johnson RM, McGuire EJ (1981) Urogenital complications of anterior approaches to the lumbar spine. Clin Orthop 154: 114–118

    Google Scholar 

  34. Kaneda K (1981) Anterior approach and Kaneda instrumentation for lesions of the thoracic and lumbar spine. In: Bridwell KH, Dewald RL (eds) Textbook of spinal surgery. Lippincott, Philadelphia, pp 959–990

    Google Scholar 

  35. Kemp HBS, Jackson JW, Jeremiah JD, Hall AJ (1973a) Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg [Br] 55: 699–714

    Google Scholar 

  36. Kemp HBS, Jackson JW, Jeremiah JD, Cook J (1973b) Anterior fusion of the Spine for Infective Lesions in Adults. J Bone Joint Surg [Br] 55: 715–734

    Google Scholar 

  37. King DM, Mayo KM (1973) Infective lesion of the vertebral column. Clin Orthop 96:248–253

    Google Scholar 

  38. Kirkaldy-Willis WH, Thomas TG (1965) Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. J Bone Joint Surg [Am] 47: 87–110

    Google Scholar 

  39. Krbdel A, Stürz H (1989) Differenzierte operative and konservative Therapie der Spondylitis and Spondylodiscitis. Z Orthop Ihre Grenzgeb 127: 587–596

    Google Scholar 

  40. La Rocca H (1978) Infections of the spine. Clin Neurosurg 25: 296–304

    Google Scholar 

  41. Leong JCY (1990) Anterior spinal fusion for low back syndrome. In: Floman Y (ed) Disorders of lumbar spine, Aspen, Gaithersburg, pp 332–373

    Google Scholar 

  42. Lifeso RM, Weaver P, Harder EH (1985) Tuberculous spondylitis in adults. J Bone Joint Surg [Am] 67: 1405–1413

    Google Scholar 

  43. Manner G, Parsch K (1983) Spondylitis and Spondylodiscitis beim Kind. Z Orthop Ihre Grenzgeb 121: 455–456

    Google Scholar 

  44. Martin NS (1970) Tuberculosis of the spine. J Bone Joint Surg [Br] 52: 613–621

    Google Scholar 

  45. McMaster WC, Silber I (1975) A urological complication of Dwyer instrumentation. J Bone Joint Surg [Am] 57: 710–711

    Google Scholar 

  46. Medical Research Council Working Party on Tuberculosis of the Spine (1985) A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-paris jackets for tuberculosis of the spine in children on standard chemotherapy. J Bone Joint Surg [Br] 67: 103–110

    Google Scholar 

  47. Meurer A, Eysel P, Heine J (1995) Ergebnisse der operativen Behandlung der Spondylitis tuberculosa. Z Orthop Ihre Grenzgeb 144: 227–245

    Google Scholar 

  48. Nasca JR, Mc Elvein RB (1985)Aspergillus fumigatus osteomyelitis of the thoracic spine treated by excision and interbody fusion. Spine 10: 848–851

    Google Scholar 

  49. Oga M, Sugioka Y, Hobgood CD, Gristina AG, Myrvik QN (1988) Surgical biomaterials and differential colonization by Staphylococcus epidermidis. Biomaterials 9: 285–289

    Google Scholar 

  50. Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine 18: 1890–1894

    Google Scholar 

  51. Parthasarathy R (1985) Madras study of tuberculosis of spine. assessment and follow-up. In: Shanmugasundaram TK (ed) Current concepts in bone and joint tuberculosis. International Bone and Joint Tuberculosis Club, Madras, pp 10–12

    Google Scholar 

  52. Peters KM, Schwanitz B, Zilkens KW (1992) Spondylodiscitis -eine häufig spat gestellte Diagnose. Orthop Prax 28: 108–112

    Google Scholar 

  53. Rajasekaran S, Shanmugasundaram TK (1987) Prediction of the Angle of Gibbus Deformity in Tuberculosis of the Spine. J Bone Joint Surg [Am] 69: 503–509

    Google Scholar 

  54. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg [Am] 71: 1314–1323

    Google Scholar 

  55. Robinson BHB, Lessof MHJ (1972) Osteomyelitis of the spine. Gays Hosp Rep 110: 303–309

    Google Scholar 

  56. Schulze W (1979) Entzündliche Wirbelsäulenprozesse. Wirbelsäule Forsch Prax 83: 147–150

    Google Scholar 

  57. Silber I, McMaster W (1977) Retroperitoneal fibrosis with hydronephrosis as a complication of the Dwyer procedure. J Pediatr Surg 12: 255–257

    Google Scholar 

  58. Stevenson FH, Manning CW (1962) Tuberculosis of the spine treated conservatively with chemotherapy. Tubercle 43: 406–410

    Google Scholar 

  59. Stolke D, Seifert V, Kunz U (1988) Die postoperative Discitis intervertebralis lumbalis. Z Orthop Ihre Grenzgeb 126: 666–670

    Google Scholar 

  60. Wedge JH, Oryschak AF, Robertson DE, Kirkaldy-Willis WH (1977) Atypical manifestations of spinal infections. Clin Orthop 123: 155–263

    Google Scholar 

  61. Woolsey RM (1986) Aortic laceration after anterior spinal fusion. Surg Neurol 25:267–268

    Google Scholar 

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Authors and Affiliations

  1. Orthopaedic University Hospital Mainz, Langenbeckstrasse 1, D-55101, Mainz, Germany

    P. Eysel, Ch. Hopf, I. Vogel & J. -D. Rompe

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  1. P. Eysel
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  2. Ch. Hopf
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  3. I. Vogel
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  4. J. -D. Rompe
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Eysel, P., Hopf, C., Vogel, I. et al. Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?. Eur Spine J 6, 152–157 (1997). https://doi.org/10.1007/BF01301428

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