gms | German Medical Science

Objective: Thoracolumbar spondylodiscitis often affects elderly and multimorbid patients. The resulting destruction of the disc and vertebral body can lead to spinal instability, therapy-refractory pain, and immobilization. A minimally invasive instrumentation with a percutaneous/transmuscular pedicle screw and rod system might be safe and sufficient to effectively restore the stability of the spine, and allow for fast pain reduction and ambulation.

Methods: Retrospective single center analysis of patients receiving a navigation-guided and 3D-imaging (O-arm^®) controlled minimally invasive posterior instrumentation for thoracolumbar spondylodiscitis including cases with additional microsurgical drainage of epidural empyema. Demographic and perioperative data were extracted from electronic records. Comorbidities were quantified using the Charlson Comorbidity Index (CCI; score increases with disease severity). Operation time, intraoperative details, complications, and revision surgeries were meticulously analyzed. On postoperative CT scans the screw position was graded using the Gertzbein and Robbins classification. Outcome at hospital discharge was assessed with help of the Macnab criteria.

Results: We included 17 patients (m: n=11) with a median age of 72 years and a median CCI of 3 that were operated between 1/2013 and 10/2016. The median postoperative length of stay was 14 days. In 3 patients instrumentation included 1 segment, in 6 patients 2 segments, and in 8 patients ≥3 segments. Additional empyema drainage was carried out in 5 Patients. The median operation time was 187 minutes, and the median blood loss was 275 ml. Intraoperative screw revisions had to be conducted in 2 instances. The postoperative screw position was as follows: No breach: 97 screws; breach ≤2 mm: 8 screws; breach 2-4mm: 2 screws. Reoperation was necessary in 1 patient due to dislocation of the rod. There was no further surgery-related complication. 2 patients died during the hospital course 28 and 53 days after surgery, respectively, due to medical complications. The median Macnab Score at discharge was 2 indicating a good clinical outcome.

Conclusion: A minimally invasive image-guided posterior instrumentation allows for safe and effective treatment of spinal instability and pain due to thoracolumbar spondylodiscitis. However, long-term outcome including the ability to cure the infection in combination with standard antibiotic treatment has to be clarified in further studies.