title: Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis.
abstract: BACKGROUND
  Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.
  
  
  METHODS
  We retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.
  
  
  RESULTS
  The average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.
  
  
  CONCLUSIONS
  Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.
authors.forename: Tung-Yi
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, No, 5, Fusing Street, Guishan Township, Taoyuan 333, Taiwan. tsai1129@gmail.com.
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.forename: Meng-Ling
authors.initials: ML
authors.lastname: Lu
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Ming-Kai
authors.initials: MK
authors.lastname: Hsieh
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D003646:Debridement / Q000295:instrumentation / Q000379:methods; D015299:Discitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D065289:Pedicle Screws; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome