Abstract
ObjectiveSurgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis.MethodsThis was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively.ResultsThe mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05).ConclusionOne‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.
Highlights
Spondylodiscitis is an infection that is associated with the destruction of the intervertebral disc
Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients
One-stage debridement with autogenous iliac bone graft through the oblique lateral interbody fusion (OLIF) corridor combined with posterior pedicle screw fixation is effective and safe for single-level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails
Summary
Spondylodiscitis is an infection that is associated with the destruction of the intervertebral disc. Pyogenic spondylodiscitis is caused by pathogens such as the Staphylococcus species, Escherichia coli, and Mycobacterium tuberculosis. It is a rare condition, accounting for only 2%–7% of all osteomyelitis[1]. Without a confirmed positive culture, only empiric treatment with antibiotics can be used, which might have inappropriate results. Such infections often produce epidural abscesses or neurological symptoms, which cannot be addressed by antibiotics alone 6. Rutges et al.[7] report that treatment with antibiotics alone is ineffective in approximately 10% of patients, making surgery necessary
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