Treating pyogenic lumbar spondylodiscitis with lateral debridement and fusion (XLIF): A retrospective study on the clinical outcomes and radiological characteristics

Abstract

Background The surgical treatment of pyogenic lumbar spondylodiscitis (PLS) remains a controversial topic. Traditional posterior open surgery involves significant surgical trauma, non-direct vision debridement, and the possibility of bringing the front infection to the back. In contrast, extreme lateral interbody fusion (XLIF) offers several advantages over traditional open surgery, including minimal trauma, less bleeding, a shorter recovery period, and direct vision debridement. The objective of this study is to assess the safety and feasibility of XLIF for treating PLS, mainly focusing on evaluating the indirect decompression. Methods This retrospective study included 30 patients who were diagnosed with PLS and underwent XLIF and posterior fixation in the First Affiliated Hospital of the Army Medical University from 2015 to 2021. The clinical outcomes were assessed using the Oswestry Disability Index (ODI), visual analogue scale scores (VAS), American Spinal Injury Association (ASIA) grade and modified Macnab criteria. Radiological characteristics including lumbar sagittal balance and indirect decompression parameters were evaluated using lumbar X-ray and CT scan. The complications were recorded. Results At the final follow-up, the VAS and ODI scores were significantly reduced, and the ASIA grades were improved in all cases. The global and segmental lumbar lordosis were restored. Moreover, the postoperative indirect decompression parameters, including the disc height, foraminal height and area, central canal area and diameter, were all increased significantly. Inflammatory markers decreased to normal level at 3 months postoperatively. Bony fusion was achieved for all cases and the excellent/good rate was 100% at the final follow-up. There was no recurrency and severe complication recorded. Conclusions XLIF is a suitable alternative to traditional open surgeries in treating PLS. It is a minimally invasive surgery that involves radical debridement while achieving sufficient decompression. Trail registration: This clinical study was retrospectively registered in the First Affiliated Hospital of the Army Medical University on May 14, 2019 with the registration number KY201959.