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Abstract
Study design
To present preliminary results of PLIF (Posterior lumbar interbody fusion) and pedicle screw fixation in the lumbar pyogenic discitis.
Objectives
To evaluate the advantages and effects of PLIF and posterior instrumentation over recurrence of infection in lumbar pyogenic discitis which are resistant to antibiotics.
Summary of Literature Review
To the date, anterior removal of the focus followed by interposing autogenous bone graft without additional instrumentation and postoperative longterm immobilization has been the standard operative procedure.
Materials and Methods
10 consecutive patients who had lumbar pyogenic discitis were treated by posterior approach from October 1997 to March 1999.
Results
Based on MRI or CT finding, 9 solid union at 3~4 months after operation and 1 suspicious union at 1 year after operation were observed. The mean preoperative lordotic angle of the affected segments was 9°, compared to 20° after postoperation and 17°at last follow up. As for functional result of Kirkaldy-Willis, outcome was excellent in 3, good in 5, fair in 2, none poor case. The duration of postoperative bed rest period was an average of 3 days.
Conclusions
PLIF with instrumentation in lumbar pyogenic discitis is a useful treatment in posterior epidural abscess, coexis-tent spinal stenosis and lower lumbar level where anterior fixation is impossible. It is especially indicated in the case of scanty antevertebral abscess with minimal bone destruction. Its main advantage is early ambulation.
REFERENCES
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Fig. 1-A.
Lateral radiographs shows L5-S1 disc space narrowing and irregular end plates. Fig. 1-B. T2-weighted image reveal a high intensity epidural abscess and destruction of the end plate. Als note the increased signal intensity in the involved surrounding vertebral bodies. Fig. 1-C. Follow-up lateral radiography, made 1 year 9 months after the operation, reveal solid fusion. Fig. 1-D. The CT scan demonstrates fusion between L5 and S1.
Table 1.
Summarized data of 10 patients with pyogenic lumbar discitis
| Number | Age/Sex | Level | Epidural abscess | Spinal disorder | Surgical procedure | Screw fixation | Culture | Functional results | Complication |
|---|---|---|---|---|---|---|---|---|---|
| 1 | F/77 | L3-L4 | None | L3-L5 stenosis | L3-L5 Lam∗ with cancellous PLIF† | L2, L3, L4, L5 | Cheryseomonas luteola | Excellent | None |
| 2 | M/53 | L5-S1 | Ventral | L4-5 HNP+ | L5-S1 Lam with strut PLIF | L5, SI | No growth | Good | Superficial wound infection |
| 3 | F/47 | L5-S1 | Dorsal | L5-S1 post surgical stenosis | L5-S1 Lam with strut PLIF | L4, SI | No growth | Good | None |
| 4 | F/70 | L4-L5 | Ventral | L4-L5 stenosis | L4-L5 Lam with strut PLIF | L4, L5, SI | No growth | Excellent | Esophageal candidasis |
| 5 | F/51 | L4-L5 | Ventral | None | L4-L5 Lam with strut PLIF | L4, SI | No growth | Good | Nerve root irritation |
| 6 | F/69 | L4-L5 | None | L4-L5 stenosis | L4-L5 Lam with strut PLIF | L4, L5 | Burkholderia cepacia | Excellent | None |
| 7 | M/57 | L3-L4 | Ventral | L3-L4 post surgical stenosis | L3-L4 Lam with strut PLIF | L3, L4 | Staphylococcus aureus | Fair | None |
| 8 | M/60 | L4-L5 | Dorsal | L3-L5 stenosis with strut PLIF | L3-L5 Lam Staphylococcus | L3, L4, SI | Fair aureus | None | |
| 9 | F/65 | L5-S1 | Ventral | None | L5-S1 Lam with strut PLIF | L5, SI | No growth | Good | Nerve root irritation |
| 10 | F/51 | L4-L5 | Ventral | L3-L5 stenosis | L3-L5 Lam with strut PLIF | L2, L3, L4, L5 | No growth | Good | None |
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