gms | German Medical Science

Objective: Surgical treatment for spondylodiscitis is still a matter of discussion and practiced among spinal surgeons in different ways. Stand-alone pedicle screw insertion in the acute phase is a commonly used treatment option. However multi-level pedicle screw instrumentation without ventral instrumentation may not result in sufficient long-term fusion. The aim of this retrospective and prospective case collection study of spondylodiscitis patients treated by stand-alone pedicle screws was to evaluate fusion rates.

Method: 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments including decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. Patients were contacted 6-24 months after surgery for ODI and clinical course assessment.

Results: 24 patients were treated by free-hand fluoroscopy guided surgery (group A, 122 screws) and 66 patients were treated by percutaneous robotic-guided spinal instrumentation (group B, 333 screws). 85.8% of robotic-guided screws and 67.2% of free-hand screws were found to be accurate (grade 0 and 1 according to Wiesner et al.). The average intra-operative X-Ray exposure per screw was 0.96 ± 0.84 min in group A compared to 0.38 ± 0.17 min in group B (p=0.002). Intraoperative adverse events (hemorrhage, dural tears) were observed in 20.8% (5) of group A and 7.5% (5) of group B. 37.5% (6) in group A and 6% (4) in group B required wound revision. Implant revision due to misplacement was necessary in (6 screws) 4.9% in group A and (1 screw) 0.33% in group B; in the further course due to implant loosening in 2 patients (8.3%) of group A and 5 patients (7.5%) of group B. Until now only in 12 patients postoperative CT-imaging was necessary, because of clinical symptom of any kind. Among those 91.6% showed a solid bony fusion. Except for 1 patient who received ventral instrumentation at another institution, no patient necessitated further surgical treatment for any reason within the follow-up period. Postoperative ODI ranged from 12-20 corresponding to minimal disability.

Conclusions: This study demonstrates that in lumbar and thoracic spondylodiscitis pedicle screw instrumentation with or without debridement of the necrotic disc space in combination with antibiotics is sufficient to control the disease. Robotic-guided instrumentation provides higher accuracy of implant placement, decreased complication rates, less perioperative adverse events and lower radiation exposure.