Anterior cervical spine surgery for the treatment of subaxial cervical spondylodiscitis: a report of 30 consecutive patients

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Infection of the cervical spine is a rare disease but is associated with significant risk of neurological deterioration, morbidity, and a poor response to nonsurgical management. The ideal treatment for cervical spondylodiscitis (CSD) remains unclear.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Hospital records of patients who underwent acute surgical management for CSD were reviewed. Information about preoperative neurological status, surgical treatment, peri- and postoperative processes, antibiotic treatment, repeated procedure, and neurological status at follow-up examination were analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 30 consecutive patients (17 male and 13 female) were included in this retrospective study. The mean age at procedures was 68.1 years (range 50–82 years), with mean of 6 coexisting comorbidities. Preoperatively neck pain was noted in 21 patients (70.0%), arm pain in 12 (40.0%), a paresis in 12 (40.0%), sensory deficit in 8 (26.7%), tetraparesis in 6 (20%), a septicemia in 4 (13.3%). Preoperative MRI scan revealed a CSD in one-level fusion in 21 patients (70.0%), in two-level fusions in 7 patients (23.3%), and in three-level fusions in 2 patients (6.7%). In 16 patients an antibiotic treatment was initiated prior to surgical treatment. Anterior cervical discectomy and fusion with cervical plating (ACDF+CP) was performed in 17 patients and anterior cervical corpectomy and fusion (ACCF) in 12 patients. Additional posterior decompression was performed in one case of ACDF+CP and additional posterior fixation in ten cases of ACCF procedures. Three patients died due to multiple organ failure (10%). Revision surgery was performed in 6 patients (20.7%) within the first 2 weeks postoperatively. All patients received antibiotic treatment for 6 weeks. At the first follow-up (mean 3 month) no recurrent infection was detected on blood workup and MRI scans. At final follow-up (mean 18 month), all patients reported improvement of neck pain, all but one patients were free of radicular pain and had no sensory deficits, and all patients showed improvement of motor strength. One patient with preoperative tetraparesis was able to ambulate.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>CSD is a disease that is associated with severe neurological deterioration. Anterior cervical surgery with radical debridement and appropriate antibiotic treatment achieves complete healing. Anterior cervical plating with the use of polyetheretherketone cages has no negative effect of the healing process. Posterior fixation is recommended following ACCF procedures.</jats:p></jats:sec>

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

“…Age and gender distributions are similar those in previous studies [1,16,19,21,[30][31][32][33]. The lumbosacral spine is the most common site of infection [1,19,20,30,34].…”

“…Evacuation of epidural empyema within 24 h appears to have had a relative advantage over delayed surgery with regard to the discharge of the neurological grade [48]. Anterior cervical surgery with debridement and antibiotics achieved complete healing, while the use of PEEK cages had no negative effects [32,49]. Additional dorsal stabilization is recommended in cases of spinal instability and after corpectomy [32].…”

“…The lumbosacral spine is the most common site of infection [1,19,20,30,34]. Mortality is high, at 8.9%, and has been described as ranging from 1.8% to 15% [1,19,32,35]. Short-term mortality was shown to be related to empyema and neurologic deficits [5].…”

Anterior Cervical Corpectomy and Fusion for Degenerative and Traumatic Spine Disorders, Single-Center Experience of a Case Series of 119 Patients

“…An anterior approach with ACCF is widely considered a safe and effective surgical treatment to achieve spinal cord decompression and high fusion rates in degenerative pathologies as well as traumatic spinal injuries. 1 , 2 , 15 , 21 However, whether ACCF provides sufficient stability on its own, especially in multilevel ACCFs, remains controversial. Additional surgery with PF can provide extra support to improve cervical stability and is sometimes performed at the index operation or later as supplementary surgery due to material failure or instability.…”

Intelligent Three-Dimensional Reconstruction Algorithm-Based X-Ray Film for Analysis of the Changes in Sagittal Parameters and Curative Effect of Anterior Cervical Surgery

“…Anterior cervical surgery is a common method with good curative effect and relatively safe treatment for cervical degenerative diseases, trauma, tumor, inflammation, and deformity. However, the surgery is difficult, with high risk [6,7]. erefore, the transformation of sagittal parameters before and after clinical anterior cervical spine surgery is a topic worth investigating.…”