gms | German Medical Science

Objective: Spondylodiscitis and spinal epidural abscesses with severely septic and neurological complications are life-threatening diseases, which require urgent treatment. Acute spondylodiscitis requires treatment with surgical spondylodesis of the affected vertebrae. Surgical- and comorbidities-related complications usually determine the outcome of the patients. We have retrospectively analysed complications of spondylodiscitis patients after conventional open surgery versus percutaneous procedures.

Methods: We have enrolled 116 consecutive patients operated on with open (free-hand) techniques or with robotic guidance in a percutaneous way from 2008 including October 2011. Pre- and postoperative comorbidities and postoperative complications in both groups were analysed. Risk factors such as old age, diabetes mellitus, cardiovascular diseases, obesity, sepsis states, renal or hepatic insufficiency, chronic steroid or immunosuppressive intake, previous cancer, neurodegenerative and pulmonary diseases will be examined. For statistical analysis Chi-squared- and t-test were applied.

Results: A total of 85 patients were operated on using open surgery (first group) whereas 31 patients underwent percutaneous procedures with robotic guidance (second group). The median age was 72 in the first group and in the second group. 94 of 116 patients (70.7%) showed regular healing process: 67 in the first group (78.8%) and 27 in the second group (87.1%). Wound healing disorders occurred 22 patients: 18 in the first group (21.2%) and 4 in the second group (12.9%), who had further wound revision procedures with negative pressure wound therapy device. Due to the low number of patients the statement that wound healing disorders in the second group occurred rarely in comparison to the first group has not reached statistical significance, but a trend in this direction (p < 0.314). The average hospital length of stay in the first group was 37.5 days and 29.1 days in the second group (statistically significant at p < 0.037).

Conclusions: Our results have shown that percutaneous robotic-guided spondylodesis is a safe procedure and compared to the conventional open technique, it is associated with a lower wound healing complication rate and a significantly shorter hospital stay. Our data strongly suggest that percutaneous procedures should be specially considered in spondylodiscitis patients displaying a high-risk level of comorbidities.