Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis

Abstract

This study examines prospectively the randomised, long-term, clinical and radiological results of the treatment of spondylitis patients by ventro-dorsal or ventral spine fusion. Group 1 consisted of 12 patients who (after ventral removal of the focus of infection and autologous bone grafting) were treated by dorsal instrumentation. Group 2 consisted of ten patients who, after similar ventral removal and bone interposition, were stabilised by ventral instrumentation. The patients prospectively underwent clinical and radiological studies. In addition, they were asked to fill in self-assessment questionnaires such as the short-form (SF)-36 health survey, the Oswestry questionnaire, and the visual analog scales (VAS). The postoperative follow-ups were at 6 months, 2 years and 5.4 years. It proved possible to demonstrate clinically that patients with an isolated ventral spondylodesis feel significantly better and experience significantly less pain in the area of spinal fusion than patients with ventro-dorsal fusion 2 and 5.4 years after the operation. Over a number of years a stable fusion can be achieved through either operation. Ventral stabilisation yields more advantages than dorsal instrumentation in the long term. These advantages result in a clinically smoother course after the operation. If, in the individual case, ventral instrumentation is feasible, this method should be used.

Treatment of spondylodiscitis

“…Further indications for surgery are listed in Table 1. Relative indications for surgical treatment include uncontrollable pain symptoms and lack of patient compliance with conservative therapy [2,9,12,21]. The goals of surgery are debridement and removal of the septic focus, collection of specimens for microbiological testing and histopathological examination, decompression of the spinal canal, with stabilisation and restoration of the infected spine segment, and subsequent bony fusion.…”

“…Recommendations regarding the choice of interior stabilisation are equally diverse; suggested approaches include purely posterior stabilisation, anterior only, combined posterior-anterior, or combined anterior-posterior stabilisation [2,3,5,7,10,21,29,36,37]. Table 2 presents our current treatment concept of pyogenic spondylodiscitis which is based on the grade of destruction of the affected segments.…”

“…In cases of monosegmental spondylodiscitis with minor kyphosis, anterior fusion with bone graft alone might be considered [3]. By using anterior stable locking implants, sufficient stabilisation can be achieved [21,29]. Lee et al published a retrospective series of 18 patients with spondylodiscitis and slight bony destruction, treated with autologous iliac crest bone graft using the PLIF (posterior lumbar interbody fusion) technique [37].…”

“…With regard to the treatment of nonspecific spondylodiscitis, antibiotic administration from six weeks to three months has been suggested [1,5,10,20,21]. In any case, the duration of treatment depends on the condition of the individual patient.…”

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

“…Some controversy exists whether anterior and posterior approaches should be performed as single or even multiple stage procedures [8,11,18,20,21,27]. Isenberg et al report their experience in 34 patients with reduced general condition.…”