Article
Secondary deformity of sagittal profile following instrumented surgery with and without corpectomy for treatment of pyogenic spondylodiscitis
Sekundäre Deformität des Sagittalprofils nach instrumentierter Operation mit und ohne Korpektomie zur Behandlung der pyogenen Spondylodiszitis
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Authors
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Patrick Melich
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland; Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
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Bawarjan Schatlo
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Christoph Bettag
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Tammam Abboud
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Pyogenic spondylodiscitis is associated with significant morbidity and mortality. Secondary spinal deformity may arise due to vertebral body collapse. Despite growing number of studies on the subject, there is no consensus on the threshold for 360° fusion compared to stand-alone posterior approach. The aim of the current study is to assess secondary deformity of sagittal profile and evaluate the difference between 360° fusion and posterior stabilization in this regard.
Methods: We retrieved radiological data of 90 patients who underwent instrumented surgery for pyogenic spondylodiscitis at our institution between 2010-2017. Kyphosis angle in the thoracic spine and lordosis angel in the lumbar spine were measured between the endplates above and beneath the involved discs and vertebrae. This measurement was performed using CT- imaging prior to the surgery, postoperatively and at follow-up. We applied paired T-test to compare measured angles and T-test to compare the angle changes between patients who received posterior instrumentation and those who received 360° fusion.
Results: Instrumentation was conducted in the lumbar spine in 65 patients, 14% of them received 360° fusion, and in the thoracic spine in 25 patients, 44% of them received 360° fusion. Mean follow-up period was 9±3 months. Mean lordosis angels pre- and postoperatively and at follow-up were 26.4±15.8°, 28.9±16° and 24.7±14.2°, respectively. Mean kyphosis angels pre- and postoperatively and at follow -up were 12.3± 6.7°, 11.1±7.1° and 16.3±9.1°, respectively. The deformity decreased significantly after surgery in the lumbar spine and increased at follow up (P=0.034 and P=0.001, respectively), while kyphosis correction after surgery in the thoracic spine was not significant and the kyphosis increased significantly at follow-up (P=0.211 and P=0.001, respectively).
When comparing posterior instrumentation with 360° fusion, the only significant difference was found in the lumbar spine where the positive change in the lordosis angle was higher at follow up in patients with 360° fusion than in those with posterior instrumentation (mean 3.6±7.2° and -2.5±8.5°, p=0.045).
Conclusion: Following instrumented surgery for treatment of pyogenic spondylodiscitis, secondary deformity of the sagittal profile occurred in the lumbar and thoracic spine. 360° fusion might be of higher value in the lumbar spine than in the thoracic spine. Larger and perhaps prospective series are needed to validate these results.
