Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis

Patel, Neal B.; Dodd, Zachary H.; Voorhies, Jason M.; Horn, Eric M.

doi:10.1016/j.jocn.2015.03.061

Cited by 33 publications

(20 citation statements)

References 19 publications

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“…In lumbar interbody fusion, MIS-TLIF (minimally invasive transforaminal interbody fusion) had better ODI, VAS pain, and complication rate when compared to XLIF with direct and indirect meta-analysis methods;however, in terms of fusion rates, there were no differences between the two techniques[ 44 ].Radiological outcome showed similar results in patients with degenerative spinal canal stenosis and spondylodiscitis. Improvement of regional lordosis (increase of sagittal L1-S1 angle of 36.2⁰ preoperative vs. 38.09⁰ postoperative) showed consistence with previous studies[ 7,25,29,30 ]. However, measurement of the regional and segmental coronal Cobb angles did not show correction but rather a slight angle increase (4.28⁰ preoperative vs.…”

supporting

confidence: 90%

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

Pojskić

Saß

Völlger

et al. 2021

Bosn J of Basic Med Sci

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Extreme lateral interbody fusion (XLIF) has become the standard of minimally invasive lumbar segmental scoliosis treatment. Our objective is to determine the safety and efficacy of XLIF in spinal canal stenosis (SCS) and spondylodiscitis (SD). Patients treated with XLIF in our department between 2012 and 2018 were retrospectively analyzed. Patient records with clinical and radiographical parameters were evaluated. The patient cohort consists of 40 male and 32 female patients with a median age of 66.6 years. Forty-five patients had an SCS and 27 patients SD. The mean follow-up was 23 months. One level XLIF was performed in 49 patients, 2 levels in 15, 3 levels in 7 patients and 4 levels in 1 patient. All but one patient received an additional dorsal stabilization. The pain was present in all patients with a mean Visual Analogue Scale (VAS) score of 8.8 vs. postoperative VAS of 2.8 (p<0.05). Preoperative neurological deficits were found in 44 patients. Only 6 patients had a neurological deterioration, 45 patients improved, and 21 patients remained unchanged. One patient experienced a perioperative complication. Non-fusion occurred in 8 cases. There were no outcome differences regarding pain and radiological outcome between patients with SCS and SD as well as between patients with one level vs. multilevel surgery. Baseline characteristics and the radiological outcome did not differ between the two groups. Patients with SD had a higher rate of worsening of neurological deficits following surgery, a higher rate of non-fusion, and a longer hospital stay. Patients with spinal canal stenosis SCS had a longer surgery time and more frequent adjacent segment disease.

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supporting

confidence: 90%

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

Pojskić

Saß

Völlger

et al. 2021

Bosn J of Basic Med Sci

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“…Some authors have described an alternative technique for the surgical treatment of lumbar discitis and osteomyelitis using a direct lateral retroperitoneal approach, which allows for thorough debridement and anterior column reconstruction while avoiding the need to mobilize the great vessels. [ 7 19 20 ] Madhavan et al . [ 19 ] state that surgeons who are comfortable with the direct lateral retroperitoneal approach for degenerative pathology should exercise caution when adapting this approach to infectious cases.…”

Section: Discussionmentioning

confidence: 99%

“…The benefits of MIS are all highly desirable features when treating patients with a suspected infection, especially since these patients are often sick or immunocompromised with multiple comorbidities. [ 4 5 6 7 ] This paper reports a series of patients with spinal infection in whom MIS techniques were employed to obtain a quick diagnosis to enable appropriate antibiotic therapy and faster recovery from pain, reduce the disease burden, and avoid a potentially bigger operation.…”

Section: Introductionmentioning

confidence: 99%

The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

Turel

Kerolus

Deutsch

2017

J Craniovert Jun Spine

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Background:Diagnostic yields for spondylodiscitis from CT guided biopsy is low. In the recent years, minimally invasive surgery (MIS) has shown to have a low morbidity and faster recovery. For spinal infections, MIS surgery may offer an opportunity for early pain control while obtaining a higher diagnostic yield than CT-guided biopsies. The aim of this study was to review our patients who underwent MIS surgery for spinal infection and report outcomes.Methods:A retrospective review of seven patients who underwent MIS decompression and/or discectomy in the setting of discitis, osteomyelitis, spondylodiscitis, and/or an epidural abscess was identified. Patient data including symptoms, visual analog score (VAS), surgical approach, antibiotic regimen, and postoperative outcomes were obtained.Results:Of the 7 patients, 5 patients had lumbar infections and two had thoracic infections. All seven patients improved in VAS immediately after surgery and at discharge. The average VAS improved by 4.4 ± 1.9 points. An organism was obtained in 6 of the 7 (85%) patients by the operative cultures. All patients made an excellent clinical recovery without the need for further spine surgery. All patients who received postoperative imaging on follow-up showed complete resolution or dramatically improved magnetic resonance imaging changes. The follow-up ranged from 2 to 9 months.Conclusions:MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery.

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“…14 studies demonstrating the role and efficacy of the lateral retroperitoneal transpsoas approach for decompression and debridement of refractory discitis. [34][35][36] Most reports of MIS techniques for spinal infections have focused on percutaneous CT-guided or fluoroscopy-guided needle biopsy, which can be more accessible and cost-effective but at times produce unreliable results for certain subsets of lesions. 37 Reasons for the relatively low microbiological yield of CTGB in the setting of infection may include the lack of precise visualization of the target lesion, variable expertise of those performing the biopsy, indolent nature of the pathogen, and/or lesion size and composition.…”

Section: Lessonsmentioning

confidence: 99%

A minimally invasive lateral approach with CT navigation for open biopsy and diagnosis of Nocardia nova L4–5 discitis osteomyelitis: illustrative case

Zheng

Abdulrazeq

Leary

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDLumbar spine osteomyelitis can be refractory to conventional techniques for identifying a causal organism. In cases in which a protracted antibiotic regimen is indicated, obtaining a conclusive yield on biopsy is particularly important. Although lateral transpsoas approaches and intraoperative computed tomography (CT) navigation are well documented as techniques used for spinal arthrodesis, their utility in vertebral biopsy has yet to be reported in any capacity.OBSERVATIONSIn a 44-year-old male patient with a history of Nocardia bacteremia, CT-guided biopsy failed to confirm the microbiology of an L4–5 discitis osteomyelitis. The patient underwent a minimally invasive open biopsy in which a lateral approach with intraoperative guidance was used to access the infected disc space retroperitoneally. A thin film was obtained and cultured Nocardia nova, and the patient was treated accordingly with a long course of trimethoprim-sulfamethoxazole.LESSONSThe combination of a lateral transpsoas approach with intraoperative navigation is a valuable technique for obtaining positive yield in cases of discitis osteomyelitis of the lumbar spine refractory to CT-guided biopsy.

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Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis

Cited by 33 publications

References 19 publications

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

A minimally invasive lateral approach with CT navigation for open biopsy and diagnosis of Nocardia nova L4–5 discitis osteomyelitis: illustrative case

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