title: Spontaneous Pyogenic Spondylodiscitis in the Thoracic or Lumbar Spine: A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive and Open Surgery Over a Nine-Year Period.
abstract: OBJECTIVE
  Pyogenic spondylodiscitis is a rare disease, but its incidence is increasing. Over the last decade, spinal surgery has been modified to become minimally invasive. In degenerative spinal disorders, such minimally invasive surgery (MIS) reduces blood loss, muscular trauma, and the hospital stay. However, it is not known whether MIS also confers these benefits to patients with pyogenic spondylodiscitis. This retrospective cohort study compared the safety and efficacy of MIS and the conventional open surgical procedure in patients with pyogenic spondylodiscitis.
  
  
  METHODS
  The study cohort consisted of all consecutive patients who underwent surgery for thoracic or lumbar pyogenic spondylodiscitis that was not caused by previous surgery or tuberculosis in our tertiary-care institution between January 2003 and December 2011.
  
  
  RESULTS
  Of the 148 eligible patients, 75 and 73 underwent MIS and open surgery, respectively. The 2 groups did not differ in terms of age, body mass index, American Society of Anaesthesiologists score, comorbidities, septic disease, or preoperative neurologic deficit. The 2 methods were associated with similar postoperative stays in the intensive care unit, overall hospital stays, complication rates, and postoperative survival. However, MIS was associated with a significantly shorter operating time, a lower perioperative need for blood products, and, as expected, an increased intraoperative fluoroscopy duration.
  
  
  CONCLUSIONS
  Our 9-year experience suggests that MIS is safe and effective for spontaneous pyogenic thoracic and lumbar spondylodiscitis.
authors.affiliation: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma-, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany. Electronic address: Lennart.viezens@med.uni-goettingen.de.
authors.forename: Lennart
authors.initials: L
authors.lastname: Viezens
authors.affiliation: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Spine Surgery, Klinikum Bad Bramstedt, Bad Bramstedt, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schaefer
authors.affiliation: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rachel
authors.initials: R
authors.lastname: Helmers
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Schroeder
authors.affiliation: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Spine Surgery, Parkklinik Manhagen, Hamburg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Hansen-Algenstaedt
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015299:Discitis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
keywords: Minimally invasive surgery; Pyogenic spondylodiscitis; Spinal infection