Journal List > J Korean Soc Spine Surg > v.23(Suppl 1) > 1076107

Kim, Park, and Rhyu: Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis - Preliminary Report -

Abstract

Study Design

Retrospective clinical study.

Objectives

To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis.

Summary of Literature Review

Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders.

Materials and Methods

Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups.

Results

Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases.

Conclusions

The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.

REFERENCES

1. Danner RL, Hartmann BJ. Update of spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987; 9:265–74.
crossref
2. Tyrrel PNM, Cassar-Pollucino VN, McCall IW. Spinal infection. Eur Radiol. 1999; 9:1066–77.
3. Stabler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am. 2001; 39:115–35.
4. Hadjipavlou AG, Mader JT, Necessary JT, et al. Hematog-enous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976). 2000; 25:1668–79.
crossref
5. Klockner C, Valencia R. Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tubercu-lous spondylodiscitis. Spine (Phila Pa 1976). 2003; 28:1036–42.
6. Skaf GS, Domloj NT, Fehlings MG, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010; 3:5–16.
crossref
7. Zarghooni K, Rö llinghoff M, Sobottke R, et al. Treatment of spondylodiscitis. Int Orthop. 2012; 36:405–11.
crossref
8. Hee HT, Majd ME, Holt RT, et al. Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech. 2002; 15:149–56.
crossref
9. Dimar JR, Carreon LY, Glassman SD, et al. Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976). 2004; 29:326–32.
crossref
10. Korovessis P, Petsinis G, Koureas G, et al. Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine (Phila Pa 1976). 2006; 31:1014–9.
11. Lee JS, Suh KT. Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br. 2006; 88:765–70.
crossref
12. Ha KY, Shin JH, Kim KW, et al. The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis. Spine (Phila Pa 1976). 2007; 32:1856–64.
crossref
13. Pee YH, Park JD, Choi YG, et al. Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine. 2008; 8:405–12.
crossref
14. Nah KH, Cho HM, Ha KY, et al. Surgical Treatment of Pyogenic Lumbar Discitis Using Posterior Lumbar Interbody Fusion and Posterior Instrumentation. J Kor Musculoskelet Transplant Soc. 2008; 2:100–6.
15. Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009; 9:366–73.
crossref
16. Baluch DA, Patel AA, Lullo B, et al. Effect of physiologi-cal loads on cortical and traditional pedicle screw fixation. Spine (Phila Pa 1976). 2014; 39:E1297–302.
crossref
17. Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of in-sertional torque during pedicle screwing using cortical bone trajectory technique. Spine (Phila Pa 1976). 2014; 39:E240–5.
crossref
18. Oshino H, Sakakibara T, Inaba T, et al. A biomechanical comparison between cortical bone trajectory fixation and pedicle screw fixation. J Orthop Surg Res. 2015; 10:125–30.
crossref
19. Sansur CA, Caffes NM, Ibrahimi DM, et al. Biomechanical fixation properties of cortical versus transpedicular screws in the osteoporotic lumbar spine: an in vitro human cadaveric model. J Neurosurg Spine. 2016; 25:467–76.
crossref
20. Mizuno M, Kuraishi K, Umeda Y, et al. Midline lumbar fusion with cortical bone trajectory screw. Neurol Med Chir (Tokyo). 2014; 54:716–21.
crossref
21. Cheng WK, İ nceoğ lu S. Cortical and Standard Trajectory Pedicle Screw Fixation Techniques in Stabilizing Multiseg-ment Lumbar Spine with Low Grade Spondylolisthesis. Int J Spine Surg. 2015; 9:46–53.
crossref
22. Kasukawa Y, Miyakoshi N, Hongo M, et al. Short-term results of transforaminal lumbar interbody fusion using pedicle screw with cortical bone trajectory compared with conventional trajectory. Asian Spine J. 2015; 9:440–8.
crossref
23. Phan K, Hogan J, Maharaj M, et al. Cortical Bone Trajectory for Lumbar Pedicle Screw Placement: A Review of Published Reports. Orthop Surg. 2015; 7:213–21.
crossref
24. Mori K, Nishizawa K, Nakamura A, et al. Short-Term Clinical Result of Cortical Bone Trajectory Technique for the Treatment of Degenerative Lumbar Spondylolisthesis with More than 1-Year Follow-Up. Asian Spine J. 2016; 10:238–44.
crossref
25. Snyder LA, Martinez-Del-Campo E, Neal MT, et al. Lumbar Spinal Fixation with Cortical Bone Trajectory Pedicle Screws in 79 Patients with Degenerative Disease: Perioperative Outcomes and Complications. World Neurosurg. 2016; 88:205–13.
crossref
26. Mai HT, Mitchell SM, Hashmi SZ, et al. Differences in bone mineral density of fixation points between lumbar cortical and traditional pedicle screws. Spine J. 2016; 16:835–41.
crossref
27. Ninomiya K, Iwatsuki K, Ohnishi Y, et al. Radiological Evaluation of the Initial Fixation between Cortical Bone Trajectory and Conventional Pedicle Screw Technique for Lumbar Degenerative Spondylolisthesis. Asian Spine J. 2016; 10:251–7.
crossref
28. Matsukawa K, Yato Y, Imabayashi H, et al. Biomechanical evaluation of lumbar pedicle screws in spondylolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory. J Neurosurg Spine. 2016; 24:910–5.
crossref
29. Akpolat YT, İ nceoğ lu S, Kinne N, et al. Fatigue Perfor-mance of Cortical Bone Trajectory Screw Compared With Standard Trajectory Pedicle Screw. Spine (Phila Pa 1976). 2016; 41:E335–41.
crossref
30. Matsukawa K, Kato T, Yato Y, et al. Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique. Spine (Phila Pa 1976). 2016; 41:E851–6.
crossref

Fig. 1.
A 55 year old male patient (case No. 2). The initial plain roentgenograms from the initial period (A: AP, B: lateral) showed degenerative changes and severe ileus. The MRI showed signal changes for the L3 and L4 vertebral bodies with a huge paravertebral and epidural abscess (C: fat-suppressed T2-weighted sagittal image, D: T2-weighted axial image). Image (E) revealed the posterior extension of an infection through the right facet joint on the enhanced T2-weighted axial. The two-staged surgeries were done through L3-4 anterior interbody fusion and fixation of the posterior CBT pedicle screws (F: AP, G: lateral plain roentgenograms). After a 36 month follow-up period, plain film (H) showed a strong union and fixation of the operated area. A complete bony union is confirmed on the CT (I).
jkss-23-216f1.tif
Table 1.
Details of patients
No Age Sex Level F FU (Mo.) Organisms Initial CRP (mg/dl) Antibiotics Normalization of CRP (Mo.) Lordosis (°) VAS
Initial Postop. Last Initial Final
1 63 M L3-4 36 No 0.76 Ceftriaxone 2.5 9 11 10 9 3
2 55 M L3-4 36 K. pneumoniae e 8.97 Teicoplanin 2 13 15 13 8 2
3 61 M L4-5 29 No 2.45 Ceftriaxone 1 16 19 17 7 2
4 68 F L4-5 22 No 6.52 Cefepime 1.5 16 18 17 8 3
5 53 M L4-5 25 S. aureus 7.92 Vancomycin 1.5 14 17 16 8 2
6 46 F L3-4 30 S. aureus 3.37 Vancomycin 1 10 15 14 7 2
7 33 F L2-3 18 No 5.38 Cefotetan 1 8 11 7 9 1
8 73 F L3-4 13 No 4.15 Cefepime 1 11 12 8 9 4
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