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Na, Lee, Choi, Kim, Song, Noh, Kim, and Kim: One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis
Original Research

J Korean Soc Spine Surg 2010;17(1):18-25.

Published online: 18 March 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.1.18

One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

Hwa-Yeop Na, M.D., Young-Sang Lee, M.D., Joon-Cheol Choi, M.D., Woo-Sung Kim, M.D., Woo-Seok Song, M.D., Hyoun-Min Noh, M.D., Se-Jun Kim, M.D., Wan-Seok Kim, M.D.

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Sungnam, Gyounggi, Korea

Corresponding auther: Young-Sang Lee, M.D. Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center 255-2 Seohyun-dong, Bundang-gu, Sungnam-Si, Gyounggi-Do, Korea TEL: 82-31-779-0747, FAX : 82-31-779-0176 E-mail: hefirst@dmc.or.kr

Received 9 November 2008       Accepted 4 November 2009

©Copyright 2010 Korean Society of Spine Surgery

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis.

Objectives

To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach.

Summary of Literature Review

There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach.

Materials and Methods

Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings.

Results

The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9º .

Conclusion

One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.

Keywords: Lumbar spine, Spondylodiscitis, Posterior interbody fusion, Instrumentation

REFERENCES

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Fig. 1.
A 50-year-old male with L2-3 pyogenic spondylodiscitis (S. aureus). (A) Preoperative lateral plain radiograph shows destructive change and space narrowing in lumbar 2, 3 vertebrae. (B) T2-weighted MR image, (C) T1-weighted MR image, (D) Contrast-enhanced fat suppression MR image shows end plate destruction and epidural abscess. (E) Contrast-enhanced T1-weighted axial MR image demonstrating epidural abscess and left psoas abscess (F) Lateral radiograph after operation shows posterior debridement, bone graft and posterior instrumentation with infected body. (G) Lateral radiograph obtained 1 year after operation shows bony fusion.
jkss-17-18f1.tif
Fig. 2.
A 47year-old man with L5-S1 pyogenic spondylitis. (A) Preoperative lateral plain radiograph shows destructive change, disc space narrowing in L5-S1 vertebrae. (B) T2 weighted MR image, (C) Contrast-enhanced T1-Weghted MR image (D) Fat suppression MR image demonstrating end plate destruction and epidural abscess. (E, F) Contrast-enhanced T1-weighted axial MR image showing inflammatory change and epidural abscess, (G) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation at infected vertebral body. (H) Lateral radiograph obtained 5 years after operation shows bony fusion.
jkss-17-18f2.tif
Fig. 3.
A 59-year-old female who had DM, HTN, and ESRD with L45 pyogenic spondylitis. (A) Initial lateral plain radiograph shows destructive change, disc space narrowing in L4-5 vertebra. (B) T2-weighted saggital MR image. (C) Contrast-enhanced T1-weighted MR image. (D) T1-weighted axial MR image. (E) T2-weighted axial MR image demonstrating epidural abscess and both psoas abscess. (F) Lateral radiograph after operation shows correction of the deformity by means of posterior debridement, bone graft and posterior instrumentation (G) The 6-months later, lateral plain radiograph shows the progression of pyogenic spondylitis. More desctuctive vertebral body with L4 retrolisthesis.
jkss-17-18f3.tif
Table 1.
Summary of Patients’ Data
Age Sex Medical Problem Infected Level Instrumented Level Organism Epidural Abscess Psoas Major abscess Pre-Op IV-Anti (wks) Post-Op IV-Anti(day) Blood Loss(ml)
1 59/F DM, HN, ESRD L45 L3,S1 MRSA + + 24 51 800
2 47/M - L45S1 L4,L5,S1 No growth + - 8 30 1500
3 69/M DM,HN L45 L4,L5 GASP + + 2.8 80 600
4 68/F - L23 L1,L4 K.pn. + + 3.2 66 800
5 74/F DM,LC L23 L1,L4 S. aureus + + 3.0 42 3000
6 48/M - L34 L3,L4 No growth + + 2.6 42 1000
7 50/M DM L23 L2,L3 S. aureus + + 4.8 64 2500
8 63/F - L45 L4,L5 S. aureus + + 3.2 30 1200
9 58/M HN L23 L1,L4 No growth + + 4.0 32 1900
10 52/M Hypothyroidism L5S1 L5,S1 S. aureus + - 3.8 40 1100
11 66/F DM L23 L2,L3 K.pn. + + 3.2 30 1700
12 61/M - L45 L3,S1 S. aureus - - 2.6 41 900

MRSA, Methicillin Resistant Staphylococcus aureus; GASP, Group A Streptococcus pneumoniae; S. aureus, Staphylococcus aureus; K. pn., Klebsiella pneumonia; DM, diabetes mellitus; HN, hypertension; LC, liver cirrhosis

Table 2.
Radiological and Clinical Results in the 12 Patients
  Lordotic angle(′) VAS   ASIA score Bony Fusion (weeks)
  Pre-OP Pre-OP   Pre-OP Final f/u
Pre-OP Immediate Post-OP Final f/u Back Leg Back Leg Final f/u M/S M/S
1 -5 4 1 9 7 2 1 59 91/110 96/111 36
2 10 17 14 8 8 0 1 47 96/112 100/112 20
3 8 11 8 10 5 3 0 67 97/112 100/112 20
4 3 6 4 9 7 2 0 68 100/112 100/112 16
5 4 5 5 10 7 1 1 77 100/112 100/112 24
6 5 6 4 9 6 3 2 69 100/112 100/112 36
7 7 11 8 6 7 2 1 67 100/112 100/112 12
8 9 14 12 5 1 1 0 36 97/112 100/112 20
9 8 11 10 7 0 1 0 46 100/112 100/112 16
10 11 12 10 9 0 3 0 51 97/112 98/111 20
11 7 9 7 6 5 0 1 40 92/110 97/110 28
12 13 15 15 7 0 1 0 43 97/110 98/110 16

VAS, visual analogue scale; ASIA, american spinal injury association

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