title: Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: a minimum 2-year follow-up.
abstract: BACKGROUND
  Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge.
  
  
  OBJECTIVE
  The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years.
  
  
  METHODS
  A retrospective comparative cohort study in a single center.
  
  
  METHODS
  Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled.
  
  
  METHODS
  Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria.
  
  
  METHODS
  Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years).
  
  
  RESULTS
  The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion.
  
  
  CONCLUSIONS
  Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung 204, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan. Electronic address: tjhuang@adm.cgmh.org.tw.
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan.
authors.forename: Yen-Yao
authors.initials: YY
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan.
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Cheng
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan.
authors.forename: Meng-Huang
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013166:Spondylitis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Infectious spondylitis; Minimal access spinal surgery; Traditional anterior spinal surgery