Indian Journal of Orthopaedics Surgery


Lumbar pyogenic spondylodiscitis operated with posterior instrumentation, interbody debridement and fusion


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Author Details: Ravikumar TV, Mahesh M, Vinay Jain K, Sathish Kumar

Volume : 2

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 362

Article End Page : 366


Abstract

Study design: A prospective study in single-institution, single-surgeon review.
Objective: To analyze the outcome of posterior instrumentation and interbody debridement and fusion in managing lumbar pyogenic spondylodiscitis.
Summary of Background Data: Several management methods for pyogenic spondylitis have been reported, of which posterior surgical treatment with pedicle screws and debridement and decompression is one of the common methods of management with short and long segment stabilization. There are limited reports regarding the efficacy of posterior only approach with pedicle screw instrumentation involving the inflamed segments.
Methods: 32 patients with lumbar pyogenic spondylodiscitis who underwent posterior decompression and lumbar interbody fusion with bone graft and pedicle screw instrumentation including the affected segment and a level above and below were included. Postoperative recovery of neurology, ambulation and back ache score were examined for a period of 12 month. Serological infection control, radiological fusion and spinal alignment were investigated in the two monthly follow up.
Results: In all 32 patients successful treatment was achieved without any recurrence or spread of infection. Erythrocyte sedimentation rate and C-reactive protein levels were seen normalized with an average of75 days and 30 days respectively. On an average ambulation with brace was started at 2.5 days following surgery. Radiological signs of interbody fusion were noted in all the cases at a mean of 5.2 months. Average of the spinal alignment of the fixed segments became 2 degree of preop lordosis was achieved to 10 degree of postop lordosis and was maintained in the 12 months follow up. None of the patients had any signs of implant loosening or failure.
Conclusion: Debridement and interbody fusion with bone graft and posterior instrumentation of the affected segment and a level above and below is an effective method and achieves good clinical outcome and maintenance of radiological spinal alignment in lumbar pyogenic spondylodiscitis.

Keywords
: Early ambulation, Lumbar pyogenic spondylodiscitis, Maintenance, Spinal alignment, Instrumentation, Solid fusion