Article
Extrafocal percutaneous transpedicular fixation for the treatment of pyogenic spondylodiscitis
Extrafokale perkutane dorsale Stabilisierung zur Therapie der pyogenen Spondylodiscitis
Search Medline for
Authors
-
Hamdan Abdelrahman
- Helios-Klinikum Erfurt, Wirbelsäulenchirurgie, Erfurt, Deutschland; Assiut University, Assiut, Egypt
-
Emad Sadaat
- Helios-Klinikum Erfurt, Wirbelsäulenchirurgie, Erfurt, Deutschland
-
Ahmed Shawky
- Helios-Klinikum Erfurt, Wirbelsäulenchirurgie, Erfurt, Deutschland; Assiut University, Assiut, Egypt
-
Kraynovic Branko
- Helios-Klinikum Erfurt, Wirbelsäulenchirurgie, Erfurt, Deutschland
-
Ali Ezzati
- Helios-Klinikum Erfurt, Wirbelsäulenchirurgie, Erfurt, Deutschland
| Published: | June 26, 2020 |
|---|
Outline
Text
Objective: Pyogenic spondylodiscitis (PS) is a challenging disease with poor prognosis that requires immediate diagnosis and treatment. It can be treated non-surgically with antibiotics and immobilization with an external orthosis for several weeks to months. If surgical intervention is required, a combined anterior and posterior approach is usually performed. We report on our experience with a minimally invasive percutaneous transpedicular fixation (PTPF) procedure for the treatment of patients with PS.
Methods: We reviewed data of 32 patients, between 06/2013 and 06/2018, treated for PS, without extensive bone destruction or significant neurological deficit, with PTPF. Demographic, operative, and perioperative data were collected and analysed.
Results: The study included 17 women and 15 men with mean age of 73.6 years (56-90). Renal insufficiency was found in 27 and DM in 19 cases. Five cases were class II ASA-Score und 27 were class III and IV. The lumbar spine was affected in 20 patients, thoracic: 12, cervical: 2 and four patients had multifocal PS (33%). More than three segments were fixed in 18 patients. The average operative time was 88 minutes. The average blood loss was 160 ml. Intraop. biopsy for microbiological and histopathological examination was obtained in 33 patients; organisms could be isolated in 26 cases (70%). There were no intraop. complications, one patient died two days postop. due to cardiac infarction. 10 patients had been reoperated for shortening of the fixation after autofusion of the infected segments; occured in 27 patients within 6 months. Preop. VAS of 6/10 reduced to 2 at the last FU. 10 cases had ASIA-D, 9 improved postop. to ASIA-E with neurlogical improvement rate of 90%. Preop. CRP and WBC were 83.2 and 10.7 reduced to 32.5 and 8.8 at the last FU respectively.
Conclusion: The internal immobilization and antibiotic therapy without touching the infected tissue is sufficient to completely resolve the spondylodiscitis. Short and midterm outcomes are promising. A larger series and continuing follow-up examinations are necessary in order to clarify and define benefits and limitations of the presented technique.
