Abstract
BackgroundPercutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.MethodsWe retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.ResultsThe average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.ConclusionsAnterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-443) contains supplementary material, which is available to authorized users.
Highlights
Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated
Anterior debridement and interbody fusion with bone graft have been reported to serve as an effective treatment for pyogenic spondylodiscitis [1,4,5], followed by a one- or two-stage posterior instrumentation in the event of posterior element deformity or spinal instability [6]
Some studies have shown that patients with a spinal infection may be good candidates for percutaneous pedicle screw and rod fixation [8,9]; still other studies have reported some limitations to this approach [10,11]
Summary
Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. Anterior debridement and interbody fusion with bone graft have been reported to serve as an effective treatment for pyogenic spondylodiscitis [1,4,5], followed by a one- or two-stage posterior instrumentation in the event of posterior element deformity or spinal instability [6]. This additional procedure can produce better stabilization and fusion results with no adverse effect on infection control. The purpose of this study, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis
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