General Session: Tumor, Trauma, Infection, Image
Presented by: P. Tropiano - View Audio/Video Presentation (Members Only)
B. Blondel(1), P. Tropiano(2), S. Fuentes(3)
(1) Université Aix-Marseille, Orthopaedic Surgery, Marseille, France
(2) Université Aix-Marseille, Spine Unit, Marseille, France
(3) Université Aix-Marseille, Marseille, France
Introduction: Surgical management of spondylodiscitis remains challenging and these spinal disorders can be associated with pain and disability related to vertebral destruction. Minimal invasive management of these infections with percutaneous osteosynthesis and anterior approach could be an interesting alternative in order to decrease surgical risks in this fragile population.
Methods: Between 2008 and 2015, 28 cases of spondylodiscitis without neurologic deficit (20 males and 8 females) with a mean age of 60 years were included in this study. In 78% of the cases lesion with located in the lumbar spine, on the thoracolumbar junction in 7% of the cases and in the thoracic area in 14% of the cases. Surgical management was always performed using a posterior percutaneous osteosynthesis, associated with an anterior approach for discectomy (86%) or corpectomy (14%). Anterior reconstruction was performed using an intervertebral cage filled with BMP2 (19%), bone graft (77%) or an expandable vertebral body prosthesis (4%).
Results: Average preoperative VAS was at 9/10 with an average delay since first symptoms of 3 months. Percutaneous osteosynthesis was always possible, and anterior approach was performed during the same surgical session in 63% of the cases. In all the cases, standing position was possible at day 3 after the surgery and average length of stay was 10 days [4-29] with a 4/10 VAS on the day of discharge. Postoperative bacteriologic identification was possible in 67% of the cases (76% for patients without previous antibiotics). For all patients antibiotic treatment was conducted for 3 months postoperatively. On the whole series, postoperative neurologic deficit was never reported; one patient was diagnosed with a superficial infection and one patient returned to the operative room for a fracture on an adjacent level to the initial osteosynthesis. At 3 months follow-up (26 patients) instrumentation failure was never noticed and antibiotic treatment was stopped. At 1-year follow-up (53% of the patients) postoperative CT-scan showed a solid fusion in all the cases.
Discussion: Surgical management of spondylodiscitis is commonly performed in case of vertebral destruction or intractable pain. The association of posterior percutaneous osteosynthesis and an anterior approach lead to a quick and important decrease of back pain, and a return to daily activities. Operative and postoperative morbidity is low and complete resolution of the infection with a solid fusion was achieved in all the cases in this series. In these fragile patients this minimal invasive strategy can therefore be a valuable alternative.