- Background: Spinal instrumentation for spondylodiscitis is still under debate. Surgical data is limited to relatively small case series with short term follow-up. In this study, we wanted to analyse biomechanical, surgical and neurological long-term outcomes in this patient group.
Methods: We retrospectively screened the databases of two German primary care hospitals and identified 190 patients with non-specific SD between 2005 and 2014. Inclusion criteria were a) non-specific, non-tuberculous lumbar SD, b) minimum follow-up 1 year, c) Following surgical instrumentation. Clinical and radiological outcome was assessed before surgery, at discharge with a minimum of 12 months follow up.
Results: Complete data was available in 70 patients (49 male, 21 female, age 67.0±12.1 years). The median follow-up was 6.6±4.2 years. 35 patients underwent posterior stabilization and decompression alone, 35 were operated in a two-stage ventro-dorsal interbody fusion with decompression. Pre- andBackground: Spinal instrumentation for spondylodiscitis is still under debate. Surgical data is limited to relatively small case series with short term follow-up. In this study, we wanted to analyse biomechanical, surgical and neurological long-term outcomes in this patient group.
Methods: We retrospectively screened the databases of two German primary care hospitals and identified 190 patients with non-specific SD between 2005 and 2014. Inclusion criteria were a) non-specific, non-tuberculous lumbar SD, b) minimum follow-up 1 year, c) Following surgical instrumentation. Clinical and radiological outcome was assessed before surgery, at discharge with a minimum of 12 months follow up.
Results: Complete data was available in 70 patients (49 male, 21 female, age 67.0±12.1 years). The median follow-up was 6.6±4.2 years. 35 patients underwent posterior stabilization and decompression alone, 35 were operated in a two-stage ventro-dorsal interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 16±10.8 and 14±11.3° in patients with posterior instrumentation only, 19±9.6 and 16.9±9.7° in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12(34.3%) and 6(17.1%) cases following posterior instrumentation and ventro-dorsal instrumentation, respectively. Non-fusion was present in 22 (62.9%) and 11 (31.4%) cases following posterior instrumentation and 360° instrumentation, respectively. Overall length of hospital stay was 35±24.8 days. The complication rate of surgery was 18%(12/70). New neurological symptoms occurred in 7%(5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement or hardware failure and in 4% (3/70) due to intraspinal hematoma. During follow-up, there were no SD-related deaths.
Conclusion: A staged surgical approach, when appropriate, is safe and can lead to an excellent clinical and radiographic outcome in lumbar spondylodiscitis.…
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