Revision Surgery for Postoperative Spondylodiscitis at Cage Level after Posterior Instrumented Fusion in the Lumbar Spine-Anterior Approach Is Not Absolutely Indicated.

Jen-Chung Liao,Wen-Jer Chen

doi:10.3390/jcm9123833

Jen-Chung Liao, Wen-Jer Chen

Open Access

https://doi.org/10.3390/jcm9123833

Copy DOI

Abstract

Spondylodiscitis at the cage level is rare but remains a challenge for spine surgeons. In this study, the safety and efficacy of revision surgery by a posterior approach to spondylodiscitis developed at the cage level were evaluated, and these data were compared to those of patients treated with revision surgeries using the traditional anterior plus posterior approach for their infections. Twenty-eight patients with postoperative spondylodiscitis underwent revision surgeries to salvage their infections, including 15 patients in the study group (posterior only) and 13 patients in the control group (combined anterior and posterior). Staphylococcus aureus was the most common pathogen in both groups. L4-L5 was the most common infection site in both groups. The operation time (229.5 vs. 449.5 min, p < 0.001) and blood loss (427.7 vs. 1106.9 mL, p < 0.001) were the only two data points that were statistically significantly different between the two groups. In conclusion, a single posterior approach with ipsilateral or contralateral transforaminal lumbar interbody debridement and fusion plus extending instrumentation was safe and effective for spondylodiscitis developed at the cage level. This strategy can decrease the operation time and blood loss.

Highlights

Postoperative surgical site infection in spinal surgery may be a well-known complication, but remains a challenge for patients and the treating surgeon
Anterior debridement and fusion followed by an extra posterior fixation are rationally recommended for spondylodiscitis after posterior instrumented fusion [8]
The purposes of this study were to determine the safety and efficacy of revision surgery using a posterior approach to spondylodiscitis developed at the previous cage level, and to compare these data with those of patients treated with revision surgeries using the traditional anterior plus posterior approach for their infections

Summary

Introduction

Postoperative surgical site infection in spinal surgery may be a well-known complication, but remains a challenge for patients and the treating surgeon. Most cases of early postoperative spinal infections are often managed successfully by aggressive debridement and culture-guided antibiotics, even in patients with spinal instrumentation [4,5]. The most challenging cases for spinal surgeons include patients with infection developed anteriorly after posterior procedures. We hypothesized that lumbar spondylodiscitis developed at the cage level can be managed successfully by the posterior approach only, and the anterior retroperitoneal approach is not always necessary for this type of infection. The purposes of this study were to determine the safety and efficacy of revision surgery using a posterior approach to spondylodiscitis developed at the previous cage level, and to compare these data with those of patients treated with revision surgeries using the traditional anterior plus posterior approach for their infections

Methods

Results

Discussion

Conclusion