Abstract
BackgroundManagement of pyogenic lumbar spondylodiscitis still represent a major conflict and challenge in neurosurgery due to different pathogens and the different methods available for management.ObjectiveThe aim of this study was to evaluate the outcome of posterior lumbar spinal fixation with debridement as a treatment modality in the management of pyogenic lumbar spondylodiscitis.Patients and methodThis is a prospective study conducted on patients presenting to the Neurosurgery Department of Cairo University hospitals diagnosed to have either spontaneous or iatrogenic pyogenic lumbar spondylodiscitis. All cases were operated upon by surgical debridement, drainage, and posterior lumbar fixation in the same setting. Antibiotics were prescribed according to the obtained culture and sensitivity. Laboratory follow-up was done to all patients. Clinical outcome was evaluated in terms of the Denis Functional Pain Scale. Follow-up period ranged from 5 to 14 months.ResultsA total of 25 patients comprised of 15 males and 9 females with a mean age of 45.7 years (range 32–63 years) were included in this study. Nine cases had a previous lumbar discectomy surgery, and 15 cases presented with spontaneous spondylodiscitis. L4–5 level was the most frequent site of pyogenic discitis. Excellent outcome and good outcomes (score 1–3 in Denis Functional Pain Scale) were reported in 84% of the patients and poor outcomes (score 4–5) in 16%.ConclusionSurgical fixation and debridement can be considered as an effective modality in the management of pyogenic lumbar spondylodiscitis with early ambulation, good control of pain, and early hospital discharge.
Highlights
Surgical fixation and debridement can be considered as an effective modality in the management of pyogenic lumbar spondylodiscitis with early ambulation, good control of pain, and early hospital discharge
Spondylodiscitis is a pathogenic infection of the intervertebral disc usually with secondary osteomyelitis of the adjacent end plates occurring in conjunction
Antibiotic therapy, immobilization or fixation of the affected spinal segments, and debridement are essential for successful management [3, 6]
Summary
Spondylodiscitis is a pathogenic infection of the intervertebral disc usually with secondary osteomyelitis of the adjacent end plates occurring in conjunction. The incidence of spondylodiscitis varies between 1:100,000 and 1:250,000 [1, 2] and represents around 3–5% of all cases of osteomyelitis [3]. Due to its marked heterogeneity and treatment variations, limited scientific evaluation and standard management guidelines are available [5]. The principles of treatment include eradication of the underlying infection, preservation of spinal stability, neurological deficit recovery, adequate pain therapy, and realignment in cases with spinal deformity. Management of pyogenic lumbar spondylodiscitis still represent a major conflict and challenge in neurosurgery due to different pathogens and the different methods available for management
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