TRANSFORAMINAL APPROACH IN SURGERY FOR LOCALIZED INFECTIOUS SPONDYLITIS IN THE LUMBAR AND LUMBOSACRAL SPINE

Abstract

Objective. To analyze the possibilities of using transforaminal approach in surgery for infectious lesions of the lumbar and lumbosacral spine. Material and Methods . The study included 26 patients operated on for tuberculous spondylitis and nonspecific spondylodiscitis in the lumbar and lumbosacral spine. Patients in Group I (n = 12) underwent radical reconstructive surgery through anterior approach at the first stage, and single-step transpedicular fixation - at the second one. Patients in Group II (n = 14) underwent resection of vertebrae and fusion combined with transpedicular fixation through transforaminal approach. Results . Mean operative time in Group I was 280 ± 12 min, in Group II - 221 ± 17 min. Correction of segmental kyphosis in Group I was 7.0° ± 1.4°, in Group II - 5.0° ± 0.9°, and loss of correction - 0.7° ± 0.3° and 0.9° ± 0.4°, respectively. Bone block formation occurred six months after surgery in 8 (66 %) patients in Group I and in 1 (7 %) patient in Group II, and 12-36 months after surgery in 12 (100 %) and 13 (93 %) patients, respectively. The level of pain according to Denis scale decreased in the late period to 0.4 ± 0.1 in Group I, and to 1.3 ± 0.1 in Group II. Quality of life assessed with the Oswestry scale was 27 ± 1 (Group I) and 39 ± 1 (Group II) 12 months after surgery. Conclusion . Transforaminal approach is less time-consuming surgical procedure for the treatment of small forms of infectious disease of the spine. Nevertheless, the formation of interbody bone block is more efficient after radical reconstructive surgery through anterior or anterolateral approach.