10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis.

Enrico Pola,Antonio Leone,Alfredo Schiavone Panni,Luigi Aurelio Nasto,Debora Colangelo,Valerio Cipolloni

doi:10.3390/tropicalmed6030159

Abstract

Medical treatment with antibiotic therapy remains the mainstay of treatment for pyogenic spondylodiscitis (PS). Nevertheless, orthopaedic treatment is also very important in relieving pain, preventing neurological damage, and avoiding development of spinal deformities (e.g., scoliosis, kyphosis) due to spinal instability. Rigid thoracolumbosacral orthosis (TLSO) bracing is often needed in patients with PS, and average duration of treatment of 3 to 4 months. However, TLSO bracing can be poorly tolerated and limit ability of the patient to go back to a normal life. In 2004 our group developed an alternative surgical treatment to TLSO bracing by percutaneous posterior screw-rod bridge instrumentation of the infected level. This treatment allows early and free mobilization of the patients and is associated with faster recovery, lower pain scores and improved quality of life as previously reported. Herein, we report the clinical outcome of the first 3 patients who have completed the 10 years follow-up mark after the procedure. A case report is also described and details of the procedure are provided.

Highlights

Spinal infections represent 3–5% of all cases of osteomyelitis, with incidence ranging from 0.5 to 5.8/100,000 inhabitants/year [1,2]
Four to six weeks of ev antibiotic therapy followed by a variable oral course of antibiotics is the mainstay of treatment [3,5]
Microbiologic diagnosis can be obtained through blood cultures, CT-guided, percutaneous or open biopsy and it is of the utmost importance in directing correct antibiotic treatment

Summary

Introduction

Spinal infections represent 3–5% of all cases of osteomyelitis, with incidence ranging from 0.5 to 5.8/100,000 inhabitants/year [1,2]. Refers to an infection process of a disc space and adjacent vertebral bodies caused by pyogenic bacteria (e.g., S. aureus, coagulase-negative staphylococci). PS can have serious consequences including worsening pain, onset of neurological deficit, development of spinal deformities (i.e., kyphosis, scoliosis) due to disruption of structural integrity of the spine, local or haematogenous spread of the infection, multiple organ failure, and death [3,4]. Four to six weeks of ev antibiotic therapy followed by a variable oral course of antibiotics is the mainstay of treatment [3,5]. Microbiologic diagnosis can be obtained through blood cultures, CT-guided, percutaneous or open biopsy and it is of the utmost importance in directing correct antibiotic treatment

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Discussion

Conclusion