Medium-Term Follow-Up Outcomes of Anterior Debridement and Fusion Followed by Posterior Pedicle Screw Fixation in Pyogenic Spondylodiscitis

Chia-Ming Chang ； Kuang-Ting Yeh ； Ru-Ping Lee ； Tzai-Chiu Yu ； Cheng-Huan Peng ； Kuan-Lin Liu ； Jen-Hung Wang ； Wen-Tien Wu ； Ing-Ho Chen

《Formosan Journal of Musculoskeletal Disorders》 預刊文章 Pp. 1-8

https://doi.org/10.6492/FJMD.20160304

摘要

Background: Spondylodiscitis is most commonly caused by pyogenic organisms, particularly Staphylococcus aureus. Patients with spondylodiscitis typically present with back pain and lower extremity weakness. Such patients could be treated with anterior debridement, fusion with autogenous or allogenous bone grafting, and posterior instrumentation. The purpose of this study was to elucidate the medium-term surgical outcomes of patients with spondylodiscitis after they received combined anterior and posterior surgeries. Methods: The data of the patients were retrospectively collected in the department of Orthopaedics of Hualien Tzu-Chi hospital from April 2008 to August 2011. Patients who were diagnosed with spondylodiscitis by physical examination, spine plain films, magnetic resonance imaging studies, and laboratory findings with follow-up of at least 4 years were included. All patients received anterior and posterior surgeries. They were divided into 2 groups: the lumbar group, which comprised patients whose foci were at the lumbar level, and the thoracic group, which comprised patients whose foci were at the thoracic level. Functional outcomes were evaluated according to the Oswestry disability index (ODI) score for the lumbar group and Nurick score for the thoracic group. Radiographic outcomes were evaluated on the basis of the sagittal parameters of the plain films such as pelvic tilt, sacral slope, and lumbar lordosis as well as the segmental lordosis of the fused level. Results: A total of 27 patients were included. Five of them were classified as the thoracic group, and the other 22 were classified as the lumbar group. Their mean age was 56.9 years. Most of the patients had preexisting medical illness. All of the patients reached definite radiographic fusion by 12 months postoperatively. The ODI score in the lumbar group and Nurick score in the thoracic group significantly improved postoperatively. Improved sacropelvic sagittal parameters without pseudarthrosis were observed at 48 months postoperatively. Conclusion: Anterior interbody fusion with strut bone grafting and posterior instrumentation was an effective method for treating pyogenic spondylodiscitis at the medium-term follow-up.

關鍵字

Allogenous humeral strut graft ； Anterior debridement and fusion followed by posterior pedicle screw fixation ； Autogenous iliac strut graft ； Oswestry disability index ； Pyogenic spondylodiscitis