Fusion with Stabilization for the Treatment of Post-operative Lumbar Spondylodiscitis: Our Experience

Abstract

Objective: To analyse the outcome of fusion with stabilization for the treatment of postoperative lumbar spondylodiscitis. Background: Post-operative spondylodiscitis is a dreadful complication following disc surgery. Treatment option is either conservative or operative, but till date, there are no universally accepted treatment protocol. Many studies suggest early surgical intervention provides good outcome. Different mode of surgical interventions can be applied for its treatment like debridement only, debridement followed by fusion with or without stabilization. In this study, we treat all of our patients having post-operative spondylodiscitis by fusion with stabilization. Materials & methods: Retrospectively we reviewed 20 cases from January 2016 to July 2021 in Bangabandhu Sheikh Mujib Medical University and other private hospitals of Dhaka, Bangladesh. Post-operative spondylodiscitis was diagnosed according to history, specific clinical findings, laboratory and radiographic investigations. Surgery was the treatment of choice in our cases. Pre and postoperative evaluations were done by the Visual Analog scale (VAS), Nurick score for neurological outcome, Modified Kirkaldy–Willis criteria for functional outcome and Modified Lee’s criteria for fusion assessment. Results: Total number of patients was 20. Mean age was 48 years (range 22-83). Average follow-up period was 12 months. The period between the surgery and the onset of symptoms was 14 to 28 days. Pre-operative VAS score was 8.10±1.7 and post-operatively was 1.7±0.6 at the last follow-up (P< 0.001). Pre & post-operative Nurick score was 2.7 & 0.7. Functional outcome was assessed in our study by Modified Kirkaldy-Willis criteria which shows 90% patient have satisfactory outcome while 10% have unsatisfactory outcome. Modified Lee’s criteria show definitive fusion in 55%, probable fusion in 35% & possible pseudarthrosis in 10% cases. Conclusion: Early diagnosis and proper management are the keys to successful outcome of postoperative spondylodiscitis. Surgical management in the form of fusion and transpedicular fixation can give excellent results. Keywords: Sondylodiscitis, Fusion, Stabilizationp