One-stage posterior debridement, autogenous spinous process bone graft and instrumentation for single segment lumbar pyogenic spondylitis

Abstract

To compare the surgical outcomes of autogenous spinous process with iliac bone graft in managing single segment lumbar pyogenic spondylitis (PS) after posterior debridement and instrumentation. We performed a retrospective study for adult patients with single level lumbar PS. 60 patients with single segment lumbar PS underwent one-stage posterior debridement, autogenous bone graft and instrumentations. The patients were divided into Group A (autogenous iliac bone) and Group B (autogenous spinous process). Preoperative Charlson comorbidity index (CCI) was analyzed to assess the comorbidity. Low back pain was evaluated using the visual analog scale (VAS). Neurological status was assessed with the American Spinal Injury Association (ASIA) scale. Clinical infection index including the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also reviewed. Moreover, fusion and changes of sagittal alignment were investigated radiologically. There was a significantly longer operative time, hospital stay and greater blood loss in group A. The VAS scores improved significantly at each follow-up interval and post-operative VAS score was significantly lower in group B. At the last follow-up, ESR and CRP returned to normal for all patients. There was at least one grade level improvement in ASIA score. No statistical difference in corrected rate, loss of sagittal angle and lumbar lordosis was found between the two groups. There was no significant difference in fusion rate, mean fusion time and complications between the two groups. Compared with iliac bone graft, the autogenous spinous process bone graft can be less invasive and painful for the single segment lumbar PS. One-stage posterior debridement, autogenous spinous process bone graft and instrumentation can provide satisfactory results for appropriate cases.

Biomechanical Analysis of Different Internal Fixation Combined with Different Bone Grafting for Unstable Thoracolumbar Fractures in the Elderly

“…According to the clinical follow-up of elderly patients with thoracolumbar instability fracture after surgery, most of them will develop new vertebral fractures after surgery, which are often located near the cone at the treatment site. Therefore, the pyramidal biomechanical data analysis and its performance evaluation in elderly patients with fractures are the primary issues to be addressed [ 13 , 14 ].…”

Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

“…However, a TMC has a risk of subsiding or displacement, which is related to the contact area, bone strength, and surgery ( 26 , 27 ). Recently, several authors have reported on the use of SP bone for the treatment of spinal infection ( 12 , 13 , 28 ). Zhong et al ( 12 ) reviewed 35 cases treated with SP bone in one-level thoracic or lumbar tuberculosis and found that the mean bone fusion time was 12.90 ± 3.91 months.…”

Secondary Infection/Microbial Substitution in a Managed Case of Pyogenic Spondylitis

“…Recently, the effectiveness of PPS fusion without anterior debridement is reported [11,12,18,19]; the effectiveness of intradiscal drainage with PEDD has been previously reported [2,4,5,[7][8][9][10]14,15,20]. There is a recent article reported successful case series treated by one-stage posterior fixation with anterior debridement from posterior approach [21]. When infection focus is limited in anterior and middle column, we usually avoid the anterior interbody/intradiscal procedure via posterior approach because we worry about the iatrogenic infection progress to the posterior area.…”