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Chaniotakis C, Koutserimpas C, Tsantes AG, Papadopoulos DV, Tsiridis CA, Karantanas A, Alpantaki K, Hadjipavlou A. Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm. J Clin Med 2024; 13:1478. [PMID: 38592315 PMCID: PMC10935210 DOI: 10.3390/jcm13051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.
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Affiliation(s)
- Constantinos Chaniotakis
- Department of Orthopaedics and Trauma Surgery, “Venizeleion” General Hospital of Heraklion, 71409 Crete, Greece; (C.C.); (K.A.)
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Microbiology Department, Saint Savvas Oncology Hospital, 11522 Athens, Greece
| | - Dimitrios V. Papadopoulos
- Second Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 14233 Athens, Greece;
| | | | | | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, “Venizeleion” General Hospital of Heraklion, 71409 Crete, Greece; (C.C.); (K.A.)
| | - Alexander Hadjipavlou
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77550, USA;
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Musa G, Makirov SK, Chmutin GE, Susin SV, Kim AV, Antonov GI, Otarov O, Ndandja DT, Egor G C, Chaurasia B. Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy. Ann Med Surg (Lond) 2024; 86:842-849. [PMID: 38333282 PMCID: PMC10849456 DOI: 10.1097/ms9.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background For recurrent lumbar disc herniation, many experts suggest a repeat discectomy without stabilization due to its minimal tissue manipulation, lower blood loss, shorter hospital stay, and lower cost, recent research on the role of instability in disc herniation has made fusion techniques popular among spinal surgeons. The authors compare the postoperative outcomes of posterior lumbar interbody fusion (PLIF) and repeat discectomy for same-level recurrent disc herniation. Methods The patients included had previously undergone discectomy and presented with a same-level recurrent lumbar disc herniation. The patients were placed into two groups: 1) discectomy only, 2) PLIF based on the absence or presence of segmental instability. Preoperative and postoperative Oswestry disability index scores, duration of surgery, blood loss, duration of hospitalization, and complications were analyzed. Results The repeat discectomy and fusion groups had 40 and 34 patients, respectively. The patients were followed up for 2.68 (1-4) years. There was no difference in the duration of hospitalization (3.73 vs. 3.29 days P=0.581) and operative time (101.25 vs. 108.82 mins, P=0.48). Repeat discectomy had lower intraoperative blood loss, 88.75 ml (50-150) versus 111.47 ml (30-250) in PLIF (P=0.289). PLIF had better ODI pain score 4.21 (0-10) versus 9.27 (0-20) (P-value of 0.018). Recurrence was 22.5% in repeat discectomy versus 0 in PLIF. Conclusion PLIF and repeat discectomy for recurrent lumbar disc herniation have comparable intraoperative blood loss, duration of surgery, and hospital stay. PLIF is associated with lower durotomy rates and better long-term pain control than discectomy. This is due to recurrence and progression of degenerative process in discectomy patients, which are eliminated and slowed, respectively, by PLIF.
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Affiliation(s)
- Gerald Musa
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Serik K. Makirov
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Gennady E. Chmutin
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Sergey V. Susin
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Alexander V. Kim
- Department of Neurosurgery, City Clinical Hospital 68 named after Demihov
| | - Gennady I. Antonov
- Department of Neurosurgery, Central Military Clinical Hospital named after A.A Vishnevsky of the Ministry of Defense of the Russian Federation
| | - Olzhas Otarov
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Dimitri T.K. Ndandja
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Chmutin Egor G
- Department of Neurological diseases and Neurosurgery, Peoples friendship University of Russia (RUDN University), Moscow, Russia
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj , Nepal
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Encarnacion-Santos D, Nurmukhametov R, Donasov M, Volovich A, Bozkurt I, Wellington J, Espinal-Lendof M, Peralta I, Chaurasia B. Management of lumbar spondylolisthesis: A retrospective analysis of posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:99-104. [PMID: 38644921 PMCID: PMC11029118 DOI: 10.4103/jcvjs.jcvjs_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
Background One of the most frequent etiologies for spinal surgery is unstable lumbar spondylolisthesis (ULS). To decompress affected structures while maintaining or restoring stability through fusion, surgeons utilize a variety of procedures. When paired with interbody fusion, posterior fusion is most applied, resulting in greater fusion rates. The two most popular techniques for implementing spinal fusion are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). As a result, these two procedures have been assessed formally. Methodology A retrospective analysis of patients who underwent interbody fusion for lumbar stenosis through PLIF and minimally invasive (MI)-TLIF was performed. The patients were followed up for 24 months and fusion rates, Visual Analog Score (VAS), and Oswestry Disability Index (ODI) alongside the MacNab clinical outcome score, were assessed. The Bridwell interbody fusion grading system was used to evaluate fusion rates in computed tomography (CT). Results Operations were performed in 60 cases where patients suffered from ULS. PLIF was performed on 33 patients (55%) (14 males and 19 females) and 27 patients (45%) (11 males and 16 females) who underwent MI-TLIF. In 87% of our respective cohort, either the L4-5 or the L5-S1 level was operated on. Overall fusion rates were comparable between the two groups; however, the TLIF group improved more in terms of VAS, ODI, and MacNab scores. On average, MI-TLIF surgery was longer and resulted in reduced blood loss. MI-TLIF patients were more mobile than PLIF patients postoperatively. Conclusion With well-established adequate results in the literature, TLIF offers benefits over other methods used for interbody lumbar fusion in ULS or other diseases of the spine. However, MI-TLIF may procure more advantageous for patients if MI methods are implemented. In this instance, TLIF outperformed PLIF due to shorter operating times, less blood loss, faster ODI recovery, better MacNab scores, and a greater decline in VAS pain ratings.
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Affiliation(s)
| | | | - Medet Donasov
- Deparment of People of Frienship University of Russia, Moscow, Russia
| | | | - Ismail Bozkurt
- Division of Vertebrology of the NCC No. 2 (CCB RAS) FGBNU “RNTSKH in B.V. Petrovskovo Academy”, Moscow, Russia/Branford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jack Wellington
- Deparment of People of Frienship University of Russia, Moscow, Russia
| | - Miguel Espinal-Lendof
- Department of Neurosurgery, CECANOT Medical Specialties, Santo Domingo, Dominican Republic
| | - Ismael Peralta
- Department of Neurosurgery, Hospital Dr. Alejandro Cabral, San Juan de la Maguana, Dominican Repúblic
| | - Bipin Chaurasia
- Division of Vertebrology of the NCC No. 2 (CCB RAS) FGBNU “RNTSKH in B.V. Petrovskovo Academy”, Moscow, Russia/Branford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Pichler L, Li Z, Khakzad T, Perka C, Pumberger M, Schömig F. Microbial spectrum, patient-specific factors, and diagnostics in implant-related postoperative spondylodiscitis. Bone Jt Open 2023; 4:832-838. [PMID: 37918440 PMCID: PMC10622184 DOI: 10.1302/2633-1462.411.bjo-2023-0087.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Aims Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date. Methods Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication. Results A total of 32 cases of IPOS with a mean patient age of 68.7 years (37.6 to 84.1) were included. Diabetes, age > 60 years, and history of infection were identified as risk factors. Patient presentation upon admission included a mean body temperature of 36.7°C (36.1 to 38.0), back pain at rest (mean visual analogue scale (VAS) mean 5/10) and when mobile (mean VAS 6/10), as well as elevated levels of CRP (mean 76.8 mg/l (0.4 to 202.9)) and white blood cell count (mean 9.2 units/nl (2.6 to 32.8)). Pathogens were identified by CT-guided or conventional biopsy, intraoperative tissue sampling, or sonication, and Gram-positive cocci presented as the most common among them. Antibiotic therapy was established in all cases with pathogen-specific treatment in 23 (71.9%) subjects. Overall 27 (84.4%) patients received treatment by debridement, decompression, and fusion of the affected segment. Conclusion Cases of IPOS are rare and share similarities with spontaneous spondylodiscitis. While procedures such as CT-guided biopsy and sonication are valuable tools in the diagnosis of IPOS, MRI and intraoperative tissue sampling remain the gold standard. Research on known principles of PJI such as implant retention versus implant exchange need to be expanded to the field of spine surgery.
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Affiliation(s)
- Lorenz Pichler
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Zhao Li
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thilo Khakzad
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery Charité – Universitätsmedizin Berlin, Berlin, Germany
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Pahwa B, Tayal A, Chowdhury D, Umana GE, Chaurasia B. Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:373-380. [PMID: 38268688 PMCID: PMC10805162 DOI: 10.4103/jcvjs.jcvjs_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/21/2023] [Indexed: 01/26/2024] Open
Abstract
Objective We conducted a cross-sectional study to assess the preference of spine surgeons between MD for microdiscectomy and endoscopic discectomy (ED) surgery for the management of lumbar pathologies in a lower-middle-income country (LMIC). Methodology An online survey assessing the preference of spine surgeons for various lumbar pathologies was developed and disseminated in "Neurosurgery Cocktail" a social media platform. Statistical analyses were performed using SPSS software with a level of significance <0.05. Results We received responses from 160 spine surgeons having a median experience of 6.75 years (range 0-42 years) after residency. Most of the spine surgeons preferred MD over ED, preference being homogeneous across all lumbar pathologies. In ED, the interlaminar approach was preferred more frequently than the transforaminal approach. The most commonly chosen contraindication for the interlaminar approach and transforaminal approach was ≥ 3 levels lumbar disc herniation (LDH) (n = 117, 73.1%) and calcified LDH (n = 102, 63.8%), respectively. There was no significant association between the type of approach preferred (MD vs. ED; and interlaminar vs. translaminar endoscopic approach) with the type of workplace and the level of experience. Conclusion Spine surgeons were inclined toward MD over ED, due to various reasons, such as a steep learning curve, lack of training opportunities, and upfront expenses. There is a pressing need for the upliftment of ED in LMICs which requires global action.
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Affiliation(s)
- Bhavya Pahwa
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anish Tayal
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Dhiman Chowdhury
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Thavarajasingam SG, Vemulapalli KV, Vishnu K S, Ponniah HS, Vogel ASM, Vardanyan R, Neuhoff J, Kramer A, Shiban E, Ringel F, Demetriades AK, Davies BM. Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep 2023; 13:15647. [PMID: 37730826 PMCID: PMC10511402 DOI: 10.1038/s41598-023-41381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Spondylodiscitis is the commonest spine infection, and pyogenic spondylodiscitis is the most common subtype. Whilst antibiotic therapy is the mainstay of treatment, some advocate that early surgery can improve mortality, relapse rates, and length of stay. Given that the condition carries a high mortality rate of up to 20%, the most effective treatment must be identified. We aimed to compare the mortality, relapse rate, and length of hospital stay of conservative versus early surgical treatment of pyogenic spondylodiscitis. All major databases were searched for original studies, which were evaluated using a qualitative synthesis, meta-analyses, influence, and regression analyses. The meta-analysis, with an overall pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality among the early surgery patient subgroup was 8% versus 13% for patients treated conservatively. The mean proportion of relapse/failure among the early surgery subgroup was 15% versus 21% for the conservative treatment subgroup. Further, it concluded that early surgical treatment, when compared to conservative management, is associated with a 40% and 39% risk reduction in relapse/failure rate and mortality rate, respectively, and a 7.75 days per patient reduction in length of hospital stay (p < 0.01). The meta-analysis demonstrated that early surgical intervention consistently significantly outperforms conservative management in relapse/failure and mortality rates, and length of stay, in patients with pyogenic spondylodiscitis.
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Affiliation(s)
- Santhosh G Thavarajasingam
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK.
- Imperial Brain and Spine Initiative, Imperial College London, London, UK.
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany.
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
| | - Kalyan V Vemulapalli
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Sajeenth Vishnu K
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Alexander Sanchez-Maroto Vogel
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
- Faculty of Medicine, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Benjamin M Davies
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
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Ramnarayan R, Chaurasia B. The post spinal surgery syndrome: A review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:4-10. [PMID: 37213573 PMCID: PMC10198214 DOI: 10.4103/jcvjs.jcvjs_118_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
Post spinal surgery syndrome(PSSS) has always been considered only for the pain it causes. However, many other neurological deficits do happen after lower back surgery. The aim of this review is to look into the various other neurological deficits that could happen after a spinal surgery. Using the keywords, foot drop, cauda equina syndrome, epidural hematoma, nerve and dural injury in spine surgery, the literature was searched. Out of the 189 articles obtained, the most important were analyzed. The problems associated with spine surgery have been published in the literature but are much more than the failed back surgery syndrome and cause more discomfort to the patients. To bring about a more sustained and collective awareness and understanding of these complications following spinal surgery, we encompassed all these complications under the heading of PSSS.
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Affiliation(s)
- R Ramnarayan
- Department of Neurosurgery, New Hope Hospital, Chennai, Tamil Nadu, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Tang X, Li J, Wang C, Liu F, Guo J, Tan J, Song Q, Cao H, Zhang Y. Antibiotic-loaded calcium sulfate beads in spinal surgery for patients with spondylodiscitis: a clinical retrospective study. BMC Musculoskelet Disord 2022; 23:270. [PMID: 35305603 PMCID: PMC8934445 DOI: 10.1186/s12891-022-05230-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after debridement using the Quadrant channel combined with percutaneous fixation through a single-stage posterolateral approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods This study collected the data of 32 patients with spine spondylodiscitis and was surgically treated in our department from July 2015 to August 2020. The Demographic data included age, gender, involved segment, and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65% to 10%. Cobb angle was significantly improved and could be maintained at final follow-up. New bone formation was observed in all patients. There were no recurrences of infection in our study. Conclusions The posterolateral debridement and percutaneous fixation combined with antibiotic-loaded calcium sulfate beads filling are effective in the treatment of spondylodiscitis in terms of infection control, early mobilization, and recovery.
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