Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis.
BACKGROUND
Most adult patients with pyogenic lumbar or thoracic spondylodiscitis are treated with an external orthosis and antimicrobial therapy for several weeks to months. If surgical intervention is required, a combined anterior and posterior approach for debridement and fusion with autologous bone graft or titanium mesh cage is usually performed.


METHODS
We here report on our experience with the use of a minimally invasive percutaneous dorsal pedicle screw-rod spondylodesis in adult patients with pyogenic lumbar or thoracic spondylodiscitis.


RESULTS
Eight patients with lumbar, one with thoracolumbar and three with thoracic pyogenic spondylodiscitis with a mean back pain of 9/10 on the visual analog scale (VAS) and without corresponding neurological deficits were treated. Immediately after the operation, we calculated a significant reduction of the back pain on the VAS to 1.7, of leukocyte counts and C-reactive protein levels. After a mean of 61 days of continuous antimicrobial therapy during full mobilization, all patients were pain free, and leukocyte counts as well as C-reactive protein levels were normalized.


CONCLUSIONS
We conclude that minimally invasive percutaneous fixation is a feasible and effective technique to achieve immediate pain release, avoid long-term immobilization and overcome the disadvantages of a dorsoventral procedure. However, surgical complications and possible follow-up procedures supplement the patients' risks of adverse reactions of the disease.
Deininger
Martin H
MH
Department of General Neurosurgery, University of Freiburg Medical School, 79106 Freiburg, Germany. martin.deininger@uniklinik-freiburg.de
Unfried
Miriam I
MI
Vougioukas
Vassilios I
VI
Hubbe
Ulrich
U
D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001510:Bed Rest / Q000009:adverse effects; D001863:Bone Screws; D015299:Discitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D016268:Internal Fixators; D017116:Low Back Pain / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents