title: Single-stage epidural catheter lavage with posterior spondylodesis in lumbar pyogenic spondylodiscitis with multilevel epidural abscess formation.
abstract: BACKGROUND
  Despite significant advances in the conservative management of pyogenic spondylodiscitis, consecutive instability, deformity, and/or neurologic compromise demands a prompt surgical intervention. However, in rare cases involving additional multilevel epidural abscess formation, the appropriate surgical strategy remains controversial. In this retrospective cohort analyses, we evaluated the efficacy of a single-stage posterior approach with the addition of a one-time multilevel epidural lavage via the surgically exposed interlaminar fenestration of the infected segment.
  
  
  METHODS
  From January 2009 through December 2010, 73 patients presenting pyogenic spondylodiscitis with instability of the lumbar spine were admitted. In all cases, the surgical strategy included a radical resection of the affected intervertebral disc and stabilization by intervertebral fusion using a titanium cage with autologous bone grafting in a level-dependent posterior approach with additional pedicle screw-and-rod instrumentation. In cases where multilevel abscess formation was evident, the standard surgical procedure was complemented by drainage and irrigation of the abscess from posterior by carefully advancing a soft infant feeding tube via the surgically exposed epidural space under fluoroscopic guidance. All patients received complementary oral antibiotic therapy for 12 weeks and were followed-up for a minimum of 12 months postoperatively.
  
  
  RESULTS
  Ten patients (three male and seven female patients; mean age: 64.9 ± 10.9 years) presented with an additional lumbar epidural abscess extending beyond three levels proximal or distal to the infected disc. In all 10 patients the laboratory-chemical inflammatory parameters (leukocyte count, C-reactive protein) remained within the physiologic range after completing antibiotic therapy throughout the 1-year follow-up period. The plain radiographs and magnetic resonance imaging demonstrated solid fusion and the complete remission of the initial abscess formation after 3 to 6 months with no recurrence of infection, respectively.
  
  
  CONCLUSIONS
  The onetime epidural lavage presented in this small patient cohort proved to be an effective surgical adjunct with minimal exposure-related morbidity. We believe that the possibility of early mobilization and the patient's increased rehabilitation potential reduce the risk of nosocomial complications that often coincide with this multimorbid high-risk group of patients.
authors.affiliation: Department of Spine Surgery, Parkkrankenhaus Leipzig GmbH, Leipzig, Germany.
authors.forename: Sven K
authors.initials: SK
authors.lastname: Tschoeke
authors.affiliation: Department of Orthopaedic Surgery, University of Greifswald, Greifswald, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kayser
authors.affiliation: Department of Orthopaedic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gulow
authors.affiliation: Department of Orthopaedic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Nicolas von der
authors.initials: Nv
authors.lastname: Hoeh
authors.affiliation: Department of Orthopaedic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Georg von
authors.initials: Gv
authors.lastname: Salis-Soglio
authors.affiliation: Department of Orthopaedic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heyde
mesh_terms: D000368:Aged; D057785:Catheters; D015299:Discitis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D020802:Epidural Abscess / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome