Single-level lumbar pyogenic discitis treated with combined minimally invasive posterior and mini-open anterior approach: Functional outcome analysis

Abstract

Study Design: This was a retrospective study. Objective: The objective of this study was to evaluate the clinico-radiological outcome in single-level lumbar pyogenic discitis treated with single-stage combined percutaneous posterior stabilization with mini-open anterior debridement and fusion under single anesthesia. Materials and Methods: We retrospectively reviewed 27 patients with single-level lumbar pyogenic discitis who presented to our institute from January 2010 to August 2015. All the patients underwent preoperative evaluation with blood parameters including complete blood count, erythrocyte sedimentation rate, C-reactive protein, blood and urine cultures, and imaging studies. They underwent single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion with tricortical iliac crest graft under the same anesthesia. They were followed up at regular intervals with clinical and radiological assessment with minimum follow-up of 24 months. Preoperative and postoperative final follow-up assessments of neurological status, pain, and disability were conducted using the Frankel Grade scoring, visual analog scale (VAS) score, and Oswestry Disability Index (ODI), respectively. Results: This study included 10 women and 17 men (n = 27) with average age of 57 years (range: 45–73 years). The mean operative time was 194min (range: 150–230min). The mean intraoperative blood loss was 212mL (range: 100–350mL). The mean VAS score (0.56) at final follow-up was significantly lower than the mean preoperative VAS score (7.30) with P < 0.001. The ODI scores at final follow-up (mean, 13.48) were significantly lower than preoperative ODI scores (mean, 83.70) with P < 0.001. Conclusion: Single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion under one anesthesia is an effective alternative to conventional open technique as it allows thorough debridement and rigid fixation, and results in minimal blood loss and lesser postoperative complications.