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Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis.

Lin TY, Tsai TT, Lu ML, Niu CC, Hsieh MK, Fu TS, Lai PL, Chen LH, Chen WJ - BMC Musculoskelet Disord (2014)

Bottom Line: After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group.Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, No, 5, Fusing Street, Guishan Township, Taoyuan 333, Taiwan. tsai1129@gmail.com.

ABSTRACT

Background: Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.

Methods: We retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.

Results: The average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.

Conclusions: Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.

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A case of hematogenous pyogenic spinal infection. (A) Preoperative lateral radiograph showed obvious disc space narrowing with endplate erosion at L4-5, and focal kyphosis (B) MRI revealed L4-5 infectious spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and percutaneous posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed bone union without progression in focal kyphosis.
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Fig2: A case of hematogenous pyogenic spinal infection. (A) Preoperative lateral radiograph showed obvious disc space narrowing with endplate erosion at L4-5, and focal kyphosis (B) MRI revealed L4-5 infectious spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and percutaneous posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed bone union without progression in focal kyphosis.

Mentions: The patient was placed in the prone position after general anesthesia was administered. One of two kinds of minimally invasive surgery (MIS) system, either the Sextant system (Medtronic Sofamor Danek) or the Viper system (Depuy Spine), was used for each percutaneously treated patient in the study. If endplate erosion and vertebral bone destruction were relatively subtle, the involved vertebral levels were instrumented. However, if vertebral bone destruction was severe, screws were inserted at one level above and one level below the involved vertebral levels.Intraoperative fluoroscopy was used to localize the appropriate spinal levels to ensure proper placement of the pedicle screws. Four paraspinal skin incisions, each approximately 1.5 cm in length, were made. Under C-arm guidance, the Jamshidi needle was gradually advanced through the pedicle at the optimal entry point, and guide wires were inserted. While maintaining the position of the wires within the pedicle, the needle was removed and the pedicle preparation cannula was placed after dilatation. The pedicle screws were placed in the standard fashion, and the rods were placed with the aid of a rod guider. The same procedure was repeated on the other side of the spine. Plain radiographs were taken immediately after insertion to ensure the accuracy of pedicle screw placement (Figures 1 and 2).Figure 1


Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis.

Lin TY, Tsai TT, Lu ML, Niu CC, Hsieh MK, Fu TS, Lai PL, Chen LH, Chen WJ - BMC Musculoskelet Disord (2014)

A case of hematogenous pyogenic spinal infection. (A) Preoperative lateral radiograph showed obvious disc space narrowing with endplate erosion at L4-5, and focal kyphosis (B) MRI revealed L4-5 infectious spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and percutaneous posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed bone union without progression in focal kyphosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4300775&req=5

Fig2: A case of hematogenous pyogenic spinal infection. (A) Preoperative lateral radiograph showed obvious disc space narrowing with endplate erosion at L4-5, and focal kyphosis (B) MRI revealed L4-5 infectious spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and percutaneous posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed bone union without progression in focal kyphosis.
Mentions: The patient was placed in the prone position after general anesthesia was administered. One of two kinds of minimally invasive surgery (MIS) system, either the Sextant system (Medtronic Sofamor Danek) or the Viper system (Depuy Spine), was used for each percutaneously treated patient in the study. If endplate erosion and vertebral bone destruction were relatively subtle, the involved vertebral levels were instrumented. However, if vertebral bone destruction was severe, screws were inserted at one level above and one level below the involved vertebral levels.Intraoperative fluoroscopy was used to localize the appropriate spinal levels to ensure proper placement of the pedicle screws. Four paraspinal skin incisions, each approximately 1.5 cm in length, were made. Under C-arm guidance, the Jamshidi needle was gradually advanced through the pedicle at the optimal entry point, and guide wires were inserted. While maintaining the position of the wires within the pedicle, the needle was removed and the pedicle preparation cannula was placed after dilatation. The pedicle screws were placed in the standard fashion, and the rods were placed with the aid of a rod guider. The same procedure was repeated on the other side of the spine. Plain radiographs were taken immediately after insertion to ensure the accuracy of pedicle screw placement (Figures 1 and 2).Figure 1

Bottom Line: After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group.Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, No, 5, Fusing Street, Guishan Township, Taoyuan 333, Taiwan. tsai1129@gmail.com.

ABSTRACT

Background: Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.

Methods: We retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.

Results: The average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.

Conclusions: Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.

Show MeSH
Related in: MedlinePlus