Management of Anterior Column Defects in Pyogenic Spondylodiscitis: A Systematic Review

Abstract

Introduction Study design: systematic review. Study Rationale: The surgical treatment of the anterior column defect in spondylodiscitis has been controversial for a long time and continues to remain so. Many techniques are described to manage the anterior column defect either through a posterior only method, anterior only method, or a combination of both. Many of the systematic reviews trying to investigate the best evidence for management involve tubercular and pyogenic, also all spinal column levels including cervical spine in their inclusion criteria regarding the differences in pathology, biomechanics, and natural history. Objectives The objective of the article is to present the difference in effectiveness and long-term reliability of all techniques which focus only on pyogenic infections in thoracolumbar segments. Material and Methods A systematic review of literature was performed using PubMed, ISI Web of Science, and Ovid Medline databases using the same search phrase: (anterior OR vertebral body OR defect) AND (spondylodiscitis OR discitis), further search was applied through reviewing references of the included search results. Articles were reviewed by the authors based on predetermined inclusion and exclusion criteria. Results PubMed search yielded 303 results, Ovid Medline yielded 451 results, and ISI Web of Science yielded 279 results. After title review and exclusion of duplication and non-English or German language articles, 32 articles were included and after final full text review 12 articles were included and presented. Three groups were formulated: anterior, posterior, and combined. Comparison included VAS, ODI, healing percentage, kyphosis correction and its maintenance, CRP, neurology, and complications. Conclusion There is a significant superiority of the combined anterior and posterior techniques in maintenance of kyphosis correction on the long-term follow-up, otherwise, due to the diversity of the criteria of evaluation of results in different articles, more clinical research should be directed to investigate the results of surgical management of anterior column defects in pyogenic thoracolumbar levels in particular.