Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis

Abstract

BackgroundPercutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.MethodsWe retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.ResultsThe average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.ConclusionsAnterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-443) contains supplementary material, which is available to authorized users.

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

“…Historically anterior debridement combined with posterior stabilization has been the golden standard in the surgical treatment of spondylodiscitis [2]. However, since this is an elaborate procedure which can be undesirable in critically ill patients, many different less invasive procedures have been developed [16,17,29,39,40,55]. Among these less invasive procedures are solely anterior or posterior procedures, combined procedures with percutaneous posterior stabilization, and percutaneous [29,39].…”

“…No differences in clinical outcome were found and the transpedicular curettage, and drainage with posterior stabilization was suggested to be a good treatment for patients with severe co-morbidities [16]. Lin et al retrospectively assessed the difference between an open and a percutaneous approach in a combined anterior and posterior strategy [40]. They found no differences in the outcomes between the open and percutaneous groups [40].…”

“…Lin et al retrospectively assessed the difference between an open and a percutaneous approach in a combined anterior and posterior strategy [40]. They found no differences in the outcomes between the open and percutaneous groups [40]. The retrospective study by Ozturk et al analyzed if there was a difference between a sequential versus a simultaneous anterior and posterior surgery [18].…”

Pyogenic lumbar spondylodiscitis treated with transforaminal lumbar interbody fusion: safety and outcomes

“…Recently, reports on the use of percutaneously placed pedicular screws as a minimally invasive option have been published [25,26]. However, both those studies used combined surgical procedures with additional anterior debridement in conjunction with percutaneous pedicular screw fixation.…”

Clinical outcomes of Percutaneous Endoscopic Debridement and Drainage combined with Percutaneous Pedicle Screw Fixation for the treatment of Infective Spondylodiscitis

“…91.3% of bone union and an average lordosis change of 4.5 ± 9.0° were reported. Nasto reported an average increase in Cobb Angle by 1.86 ± 4.78° during the 9 months follow-up period after simple posterior PPSF [12,13,19,20]. In the above studies, the intervertebral space was either treated by bone grafting or left untouched.…”