Simultaneous versus sequential one-stage combined anterior and posterior spinal surgery for spinal infections (outcomes and complications)

Abstract

To compare simultaneous with sequential onestage (same anaesthesia) combined anterior and posterior spinal surgery in the treatment of spinal infections in terms of the operation time, blood loss and complication rate. Fifty-six patients who underwent one-stage (same anaesthesia) simultaneous or sequential anterior decompression and posterior stabilisation of the involved vertebrae for spinal infection from January 1994 to December 2002 were reviewed. In group I (n=29), sequential anterior and posterior surgery was performed. In group II (n=27), simultaneous anterior and posterior spinal surgery was performed. With regard to age and gender, there was no statistical difference between both groups (P=0.05). The analysed and compared data between the two groups included the age, gender, blood loss, operation time and postoperative complications. There was a statistically significant difference between the two groups in terms of the duration of surgery, amount of blood transfusion needed and occurrence of major postoperative complications (P<0.05). The mean correction of the kyphotic deformity was similar in both groups (P>0.05) without a subsequent loss of correction on follow-up radiographic films at a mean follow-up of 6.5 years (range, 3 to 11 years). Simultaneous anterior and posterior surgery is a good alternative procedure. It provides the ability to manipulate both anterior and posterior aspects of the spine at the same time and appears to result in less blood loss, a shorter operative time and fewer complications. However, gaining experience and the availability of two surgical teams are important factors in the success of the procedure.Résumé Nous avons voulu comparer le traitement en un temps ou en un temps avec différentes séquences thérapeu-tiques (même anesthésie) combinant voie antérieure, voie postérieure dans le traitement des affections rachidiennes en comparant la durée opératoire, les pertes sanguines et le taux des complications. 56 patients ont bénéficié, en un temps (même anesthésie) d'une décompression antérieure et stabilisation postérieure pour affection rachidienne entre janvier 84 et décembre 2002 et ont été revus. Dans le groupe I (n=29) une chirurgie type séquentielle a été réalisée, dans le groupe II (n=27) une chirurgie avec abords simultanés antérieur postérieur. Les deux groupes ont été comparés en termes d'âge, de sexe, pertes sanguines, temps opératoire et complications. il y avait une différence significative entre les deux groupes en termes de temps opératoire, pertes sanguines, avec nécessité de transfusion et de complications post-opératoires (P<0.05). La correction de la cyphose a été identique dans les deux groupes (P>0.05) sans augmentation excessive des pertes de correction après un suivi de 6.5 ans (3 à 11 par an). la chirurgie réalisée de façon simultanée par devant et par derrière est un bon procédé chirurgical, elle permet de diminuer les pertes sanguines, de raccourcir le temps opératoire et diminuer le taux des complications. Cependant, l'expérience et la po...

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

“…They found no differences in the outcomes between the open and percutaneous groups [40]. The retrospective study by Ozturk et al analyzed if there was a difference between a sequential versus a simultaneous anterior and posterior surgery [18]. No differences were found between the two study groups [18].…”

“…This resulted in 25 included studies (Table 3). Ten studies containing only a minority of tuberculosis or postoperative infection cases (2.9-38 %) were included in the review [16][17][18][27][28][29][30][31][32][33]. At total of 75 patients in the current review had tuberculosis and 52 patients had a postoperative infection, which represented, respectively, 3.1 and 2.2 % of all included patients.…”

“…The retrospective study by Ozturk et al analyzed if there was a difference between a sequential versus a simultaneous anterior and posterior surgery [18]. No differences were found between the two study groups [18]. Two studies retrospectively compared the effectiveness of anterior fusion with different types of cages and cage versus strut graft [41,42].…”

“…Fifteen of the included studies contain a minority of patients that no completely meet our inclusion criteria [4, 16-18, 27-36, 44]. Ten studies include a small number patients with tuberculosis and postoperative infections representing, respectively, 3.1 and 2.2 % of the included patient in this review [16][17][18][27][28][29][30][31][32][33]. Moreover seven studies included children and adolescents representing 1.3 % of the study population of this review [4,27,32,[34][35][36]44].…”

“…Classically anterior debridement and stabilization has been the preferred treatment, since the anterior part of the spine is the most commonly involved in spondylodiscitis [2]. In recent literature, however, both more elaborated combined anteriorposterior approaches, less invasive posterior stabilization, or transpedicular curettage and drainage have been described [16][17][18]. Whereas the open surgical procedures are thought to reduce the loss of sagittal balance and minimize the risk of relapse, less invasive strategies are a lower burden for the patients with potentially fewer complications [16,17].…”