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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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Related in: MedlinePlus

A case of hematogenous pyogenic spinal infections. (A) Preoperative lateral radiograph showed disc space narrowing with endplate erosion at L3-4 level, and (B) MRI revealed L3-4 spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and traditional open posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed union of L3-4 interbody fusion.
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Fig3: A case of hematogenous pyogenic spinal infections. (A) Preoperative lateral radiograph showed disc space narrowing with endplate erosion at L3-4 level, and (B) MRI revealed L3-4 spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and traditional open posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed union of L3-4 interbody fusion.

Mentions: A standard posterior midline incision was made through the thoracolumbar fascia, and the paraspinous muscles were stripped bilaterally accompanied by hemostasis. After detection of the entry point, the pedicle screws were inserted, and the rods were placed (Figure 3). Similarly, the involved vertebral levels were instrumented one level above and one level below the involved vertebral levels if severe bone destruction was observed involving the infected vertebrae.Figure 3


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 infections. (A) Preoperative lateral radiograph showed disc space narrowing with endplate erosion at L3-4 level, and (B) MRI revealed L3-4 spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and traditional open posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed union of L3-4 interbody fusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: A case of hematogenous pyogenic spinal infections. (A) Preoperative lateral radiograph showed disc space narrowing with endplate erosion at L3-4 level, and (B) MRI revealed L3-4 spondylodiscitis. (C) Postoperative lateral radiograph demonstrated the presence of anterior interbody fusion with allograft and traditional open posterior pedicle screw. (D) Postoperative lateral view at two-year follow-up revealed union of L3-4 interbody fusion.
Mentions: A standard posterior midline incision was made through the thoracolumbar fascia, and the paraspinous muscles were stripped bilaterally accompanied by hemostasis. After detection of the entry point, the pedicle screws were inserted, and the rods were placed (Figure 3). Similarly, the involved vertebral levels were instrumented one level above and one level below the involved vertebral levels if severe bone destruction was observed involving the infected vertebrae.Figure 3

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