The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis.
METHODS
A retrospective clinical study.


OBJECTIVE
To assess the results of anterior strut grafting and the loss of the reduction in anterior interbody fusion and anterior interbody fusion combined with posterior instrumental fusion in pyogenic spondylodiscitis.


BACKGROUND
Resorption of the anterior graft is an ominous sign following most anterior surgery. Thus, additional posterior instrumentation has been used to prevent collapse of the anterior graft. However, its effect is controversial, and few studies have examined the fate of the anterior strut graft.


METHODS
Twenty-four consecutive patients underwent surgical treatment for pyogenic spondylodiscitis. The patients were divided into Group I (anterior interbody fusion) and Group II (anterior interbody fusion + posterior instrumented fusion). The sagittal angle, intervertebral height, and complications relating to the anterior graft were compared.


RESULTS
Solid bone fusion was achieved in 23 (95.8%) patients. The sagittal angle and the intervertebral height were similar in Groups I and II (P = 0.61, P = 0.89, respectively). In Groups I and II, the postoperative sagittal angle was maintained until 1 month after surgery (P > 0.05), but it decreased significantly by 3 months after surgery (P < 0.05). In Groups I and II, intervertebral height correction was maintained until 1 month after surgery (P > 0.05), but by 3 months after surgery, it had collapsed significantly (P < 0.05). Subsidence of the graft occurred through the damaged endplate. Group I included 1 case of graft dislodgement necessitating revision; there were no such cases in Group II. There were no recurrences of infection in either group.


CONCLUSIONS
Reduction of intervertebral height and loss of sagittal profile occurred in both groups. Complications relating to the bone graft were more common in Group I than in Group II. Despite loss of correction, both groups had a high fusion rate without recurrence of infection. The reduction of intervertebral graft height appears to be the result of destruction of the endplate either due to surgical debridement or the infective process.
Ha
Kee-Yong
KY
Department of Orthopaedic Surgery, Kang-Nam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. kyh@catholic.ac.kr
Shin
Jae-Hyuk
JH
Kim
Ki-Won
KW
Na
Ki-Ho
KH
D000368:Aged; D000369:Aged, 80 and over; D016723:Bone Remodeling; D001862:Bone Resorption / Q000209:etiology* / Q000503:physiopathology; D016025:Bone Transplantation / Q000009:adverse effects / Q000295:instrumentation*; D015299:Discitis / Q000150:complications / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008141:Lordosis / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome