Unilateral Posterolateral Approach for Spondylodiskitis

University Hospital of Patras20 enrolled

Overview

This retrospective study assess the efficacy and safety of a posterolateral unilateral approach for debridement and titanium cage insertion supplemented by contralateral transfascial screw fixation for sick patients suffering from septic thoracolumbosacral spondylodiskitis. Hematogenous pyogenic spondylodiskitis requires surgical intervention in cases of development of neurological signs, spinal instability, progressive spinal deformity and abscess. When operative treatment is indicated, an anterior approach by open thoracotomy or by a thoraco-abdominal approach or combined anterior and posterior approaches are recommended. In cases of severe sick patients anterior approach is associated with high morbidity and mortality.

Twenty consecutive sick (ASA\>III) patients, 14 men and 6 women, aged 64±14 years, suffering from single level septic thoracolumbosacral spondylodiskitis underwent an one-stage less invasively unilateral posterolateral decompression, insertion of titanium cage\& pedicle screw fixation plus contralateral transfascial pedicle screw fixation.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Discitis

Interventions

Eligibility

Sex: ALLMin age: 44 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Single-level thoracic, thoracolumbar, lumbar or lumbosacral spondylodiskitis * Medical comorbidities were present in all 20 patients. These included diabetes mellitus, chronic renal insufficiency, advanced heart insufficiency, hypertension, cortisone abuse, drug abuse and/or advanced age (\>65y). Exclusion Criteria: \-

Outcomes

Primary Outcomes

The extent of spinal cord injury (SCI) defined by the American Spinal Injury Association (ASIA) Impairment Scale

Grade A Complete lack of motor and sensory function below the level of injury (including the anal area) Grade B Some sensation below the level of the injury (including anal sensation) Grade C Some muscle movement is spared below the level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity. Grade D Most (more than 50 percent) of the muscles that are spared below the level of injury are strong enough to move against gravity. Grade E All neurologic function has returned.

Time frame: 2 years

Secondary Outcomes

Survival rate at 2,5 years

Revision surgery or "worst case scenario"

Time frame: 2,5 years

Survival rate at 10 years

Revision surgery or "worst case scenario"

Time frame: 10 years