Outcomes of multilevel vertebrectomy for spondylodiscitis

Ackshota, Nissim; Nash, Alysa; Bussey, Ian; Shasti, Mark; Brown, Luke; Vishwanath, Vijay; Malik, Zanaib; Banagan, Kelley; Koh, Eugene Y.; Ludwig, Steven C.; Gelb, Daniel E.

doi:10.1016/j.spinee.2018.06.361

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…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].…”

Section: General Characteristics Neurological Deficits and Mortalitysupporting

confidence: 85%

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Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

et al. 2021

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Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine. All the patients with spondylodiscitis of the cervical spine received instrumentation. In thoracic and lumbar spine decompression, surgery without instrumentation was performed in 26 patients as immediate surgery and in a further 28 patients in the early stages following admission, while 138 patients received instrumentation. Eighty-nine patients (37.6%) had concomitant infections. Infection healing occurred in 89% of patients. Favorable outcomes were noted in patients without concomitant infections, with a normalized CRP value and in patients who received antibiotic therapy for more than six weeks (p < 0.05). Unfavorable outcomes were noted in patients with high CRP, postoperative spondylodiscitis, and recurrent spondylodiscitis (p < 0.05). Application of antibiotic therapy for more than six weeks and normalized CRP showed a correlation with favorable outcomes, whereas concomitant infections showed a correlation with unfavorable outcomes. A detailed screening for concomitant infectious diseases is recommended.

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“…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].…”

Section: General Characteristics Neurological Deficits and Mortalitysupporting

confidence: 85%

“…The complication rate in our study was 21.5%. Revision surgeries of the posterior spinal constructs have been described in the literature as being up to 22% [31]. Other studies have shown lower complication rates [19,33,51,52].…”

Section: Surgical Therapymentioning

confidence: 99%

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

et al. 2021

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“…Multilevel spondylodiscitis after surgery is an intractable and troublesome complication, which may not be resolved by simple surgical debridement. Major open surgery has important drawbacks in patients with multilevel infection because of concern that the extensive destruction and mechanical instability of the affected segments following this type of surgery may be associated with significant rates of perioperative complications and mortality [1,50]. Minimally invasive endoscopic debridement with dilute betadine solution irrigation is an effective alternative to extensive open surgery for the treatment of single-level infectious spondylodiscitis,but the effectiveness of this procedure for extensive destruction of vertebral bodies and multilevel refractory infections may be limited because the thorough debridement of synchronous multiple lesions by endoscopic means is difficult and can exhaust both patient and surgeon [14,15,51,52].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

Zhang

Bu³

et al. 2021

BMC Musculoskelet Disord

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Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.

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“…Regarding radiological findings, most studies described stable perforation with a low rate of pseudarthrosis and cage dislocation not requiring revision surgery 36 , 38 , 39 , 47 , 48 , 49 . Up to 20% of cases involved mechanical complications 41 .…”

Section: Clinical Outcome Following Surgical Proceduresmentioning

confidence: 99%

“…The rates of repeat surgery following decompression alone were particularly high, with additional instrumentation required in most cases 50 , 51 . Ventral corpectomy on multiple floors also showed a high rate of revision surgery 49 .…”

Section: Clinical Outcome Following Surgical Proceduresmentioning

confidence: 99%

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

et al. 2021

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Background Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. Methods In a joint consensus, the members of the ‘Spondylodiscitis’ working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. Results Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.

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Outcomes of multilevel vertebrectomy for spondylodiscitis

Cited by 8 publications

References 16 publications

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

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