SINGLE-STAGE POSTERIOR CIRCUMSPINAL DEBRIDEMENT AND RECONSTRUCTION FOR THORACIC AND LUMBAR SPINAL INFECTIONS

Abstract

Anterior debridement and fusion is an accepted method to treat spinal infections. However, rehabilitation after anterior debridement and fusion is prolonged because of minor primary instability, making postoperative bed rest, casting, and orthotic devices necessary. To shorten and simplify the postoperative period, several authors have reported the addition of anterior or dorsal instrumentation, the latter referring to anterior–posterior exposure. In our opinion, single posterior circumspinal exposure can be used to debride and reconstruct the spine, and posterior fixation can also be added through it. Twelve patients who had infections of the thoracic and lumbar spine were treated surgically at Sohag University Hospital, Egypt. The patients were seven males and five females with a mean age of 47.5 years. Eight patients were infected in the thoracic spine, while the other four were infected in the lumbar spine. All patients were operated through a single posterior exposure. Posterior stabilization by transpedicular screw fixation was performed. Anterior dissection enabled debridement of the lesion and evacuation of any abscess. Then, reconstruction of the anterior column was performed followed by posterior fusion. Causative organisms were tuberculosis (TB) in eight patients, while bacteriologic testing of intraoperative samples did not find germs in four patients. The mean follow-up time was 12.7 months (range, 3–32 months). At the end of follow-up, 11 patients were still living, while 1 patient died 3 months postoperatively due to complications during a kidney operation. No active infection occurred by the end of follow-up. In conclusion, in cases of thoracic and lumbar spinal infections, single posterior exposure — although technically demanding — is sufficient to debride the infected material, decompress the neural elements, and reconstruct the spine both anteriorly and posteriorly.