Prognosis of spinal infections managed by minimal debridement: A case series in two tertiary centers

Abstract

Background: Spinal infections can be challenging in their management and include spondylitis, epidural abscess, and spondylodiscitis. Usual treatment is conservative through antimicrobials or surgery to decompress neural tissue, debride all infected tissues, and fix if needed. We propose the concept of surgery without formal debridement aiming at neural protection. Methods: The study was performed at two tertiary centers on 25 patients with clinical findings. One patient was treated conservatively and the rest surgically by laminectomy and fixation if needed. Evacuation of fluid pus was performed. In the cervical and the thoracic region, if the granulation tissue was anterior to the cord, only decompression by laminectomy was done. Results: Low back pain was present in 22 cases (88%), 16 cases (64%) had lower limb pain, and 12 cases (48%) had weakness. The level of spinal infection was lumbar in 15 cases (60%), thoracic in 9 cases (36%) cases, and cervical in 1 case (4%). The type of infection was epidural abscess in 20 cases (80%), discitis in 16 cases (64%), and vertebral osteomyelitis in 12 cases (48%). Laminectomy was performed in 20 cases (80%) and fixation in 17 cases (68%). The symptoms improved in all cases. On follow-up, the lesion was reduced in 14 patients (56%) and disappeared in 11 cases (44%). One case required ventriculoperitoneal shunt placement due to postinfectious hydrocephalus. Conclusion: Dealing with spinal infections surgically through decompression or fixation with minimal debridement of infected tissue appears to be a safe and effective method of management.

Surgical management of spontaneous thoracic and lumbar spondylodiscitis by fixation and debridement

“…[2] Turel et al mentioned the role of minimally invasive spine surgery in the management of pyogenic spinal discitis and all his patients had excellent recovery. [25] In our surgical strategy, we debrided the infected tissue as we can to help in eradication of infection, good neural tissue decompression, decreasing the recurrence, and obtaining proper fusion, in contrary, Mohamed et al did posterior fixation without debridement for vertebral body osteomyelitis and discitis only neurodecompression and as mentioned 14 patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area and reported that this strategy resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. Blondel et al, 10 patients were included in this study and treated with a two-step procedure: posterior percutaneous osteosynthesis completed by complementary intervertebral grafting through an anterior access.…”

“…Mohamed et al recorded single case of fixation looseness and another one for early superficial wound infection. [25] In Kamal et al, the wound healing problems occurred in one patient who originally underwent only drainage and debridement of infected/ necrotic tissue without instrumentation. [19] Faraj and Webb reported three patients developed deep wound infection, which responded to repeated debridement and they carried out all procedure redo for one patient with implant failure.…”

“…mentioned that low back pain was present in 22 cases (88%), 16 cases (64%) had lower limb pain (sciatic and claudication pain), and 12 cases (48%) had weakness. [ 25 ] Moreover, in Kamal et al ., all patients in their study (39 patients) had presented with back pain in addition, a total of 21 patients (21/39, 53.8%) had various degrees of neurological impairment on presentation. [ 19 ] In Waheed et al ., all the patients presented with local pain in the spine, which was more pronounced over the affected level, 34.1% of the patients had a neurological deficit.…”