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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Single-stage minimally invasive anterior debridement and fusion and dorsal percutaneous fixation in pyogenic spondylodiscitis of the elderly

Einzeitige minimalinvasive ventrale Herdausräumung und dorsale perkutane Fixierung bei pyogener Spondylodiszitis des Älteren

Meeting Abstract

  • Albrecht Waschke - Universitätsklinikum Jena, Neurochirurgie, Jena, Deutschland
  • Falko Schwarz - Universitätsklinikum Jena, Neurochirurgie, Jena, Deutschland
  • presenting/speaker Maren Klausnitzer - Universitätsklinikum Jena, Neurochirurgie, Jena, Deutschland
  • Rolf Kalff - Universitätsklinikum Jena, Neurochirurgie, Jena, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV040

doi: 10.3205/19dgnc052, urn:nbn:de:0183-19dgnc0528

Published: May 8, 2019

© 2019 Waschke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Pyogenic spondylodiscitis in the elderly is an increasingly common problem in spinal surgery. Reduced bone quality and multiple comorbidities are the main reasons for the predominant preference of conservative therapies in the past. The present retrospective analysis presents the own experiences of a single-stage surgical therapy with ventral debridement and cage placement combined with percutaneous fixation in a cohort of 35 patients over 70 years of age with spondylodiscitis of the thoracolumbar spine.

Methods: 35 patients with thoracolumbar spondylodiscitis were analyzed. The surgical indication resulted from the evidence of suppuration of the intervertebral disc space with resulting destruction of the spinal segment and clinical signs of instability or inadequate response of a previously initiated antibiotic therapy. Surgery was performed as minimally invasive microsurgical anterior debridement using XLIF or OLIF approach, followed by cage implantation and percutaneous posterior stabilization. The following data were collected: Duration of hospital stay, bone density, comorbidities, antibiotic therapy, germ spectrum, duration of surgery, perioperative complications up to 4 weeks after discharge, secondary implant-associated complications, healing status.

Results: The mean follow-up time was 14 months (range: 3–25). The median bone density was significantly reduced with 95 mg Ca-hydroxylapatite/ml (range 53–145). Median surgery times were 145 min (range 105–200) for the entire procedure including intraoperative repositioning. Perioperative mortality up to 4 weeks postoperatively was 2/35. Both deaths were due to sepsis. Implant associated complications were not reported. The median duration of the inpatient stay was 15 days (range: 8–73 d). There was a clear Dependence of the clinical condition at discharge with the condition before surgery. In 3/33 patients surgical revision was necessary due to persistent signs of spondylodiscitis.

Conclusion: Minimally invasive removal with percutaneous fixation is also a safe surgical procedure for older patients with multiple comorbidities and reduced bone quality. The reduced access morbidity does not seem to affect the effectiveness of the treatment. The indication for an operative therapy should also be broadly defined in older patients, especially in the presence of risk factors such as spinal instability or altered immune status.