Outcome of Transforminal Lumbar Thorough Debridement, Decompression, and Spondylodesis Technique in Treatment of 25 Patients with Pyogenic Spondylodiscitis

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

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.

Minimally invasive spine surgery as treatment for persistent infectious lumbar spondylodiscitis: a systematic review and meta-analysis

BACKGROUND

Antibiotic resistant infectious spondylodiscitis (IS) can cause significant morbidity for patients. Open surgical techniques were previously the only option for patients who failed antibiotic therapy. However, advances in minimally invasive surgical techniques may provide a new alternative for some patients.

METHODS

A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported inflammatory [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] and functional outcomes [visual analog scale (VAS)] for patients with antibiotic resistant IS treated with either minimally invasive or open surgery. Searches were preformed using PubMed, Embase, and Scopus from January 2015 to June 2021. Fourteen articles met inclusion criteria. One study was a Level III evidence study and the other 13 included studies were Level IV.

RESULTS

The minimally invasive surgery group showed significantly lower post-operative CRP and VAS pain scores and significantly higher post-operative ESR levels than the open group. All studies included were measured by the Downs and Black tool for potential bias.

DISCUSSION

This study showed that minimally invasive surgery is efficacious in the treatment of antibiotic resistant IS. These outcomes support minimally invasive surgery (MIS) as an effective alternative to previous open surgery techniques in certain patients after failed trails of antibiotic therapy.