Single-level Lumbar Pyogenic Spondylodiscitis Treated with Minimally Invasive Anterior Debridement and Fusion Combined with Posterior Fixation via Wiltse Approach

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences 2013-10, Vol.33 (5), p.707-712
• Main Author: 林阳 陈文坚 祝文涛 李锋 方煌 陈安民 熊伟
• Format: Article
• Language: English
• Subjects: Adult; Aged; Back Pain - complications; Back Pain - prevention & control; Bacterial Infections - complications; Bacterial Infections - microbiology; Constipation - etiology; Debridement - adverse effects; Debridement - methods; Disability Evaluation; Discitis - complications; Discitis - surgery; Escherichia coli - isolation & purification; Female; Follow-Up Studies; Humans; Lumbar Vertebrae - microbiology; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Pain Measurement; Retrospective Studies; Spinal Fusion - adverse effects; Spinal Fusion - methods; Staphylococcus aureus - isolation & purification; Staphylococcus epidermidis - isolation & purification; Streptococcus - isolation & purification; Treatment Outcome; Urinary Retention - etiology; Venous Thrombosis - etiology; 化脓性; 单级; 固定治疗; 椎间盘; 清除; 病灶; 腰椎; 金黄色葡萄球菌
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-013-1184-x

Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients＇ general information, mi- crobiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association （ASIA） im- pairment, visual analogue scale （VAS）, and Oswestry Disability Index （ODI）. Ten patients had under- gone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments in- cluded L1-2, L2-3, L3,~, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were posi- tive for Staphylococcus aureus （5 cases）, Staphylococcus epidermidis （4）, Streptococcus （3）, and Es- cherichia coli （1）. The operative time was 213.8＋45.6 min, and the intraoperative blood loss was 180.6-4-88.1 mL. Postoperative complications consisted of urinary retention （2 cases）, constipation （3）, and deep vein thrombosis （2）. On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with poste- rior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondy- lodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.