Posterior Surgical Decompression and Fusion Augmented with Internal Fixation in Thoracic and Lumbar Spondylodiscitis; is it Possible?

Abstract

Background Data: Posterior surgical treatment of spinal infections was adopted since 1912. However, most authors strictly advocated anterior or anterolateral debridement and subsequent bone grafting and fixation. These procedures often bear a high risk for elderly and debilitated patients. Purpose: To assess the efficacy of posterior surgical decompression, fusion and fixation in thoracic and lumbar spine spondylodiscitis. Study Design: A retrospective clinical case study. Patients and Methods: Fifteen patients suffering from thoracic and lumbar spondylodiscitis, both tuberculous and non-tuberculous, underwent posterior surgical decompression with posterolateral and interbody fusion augmented with posterior fixation, according to the degree of vertebral wedging, the kyphotic angle and high surgical risk for anterior procedures. Results: Neither of our patients deteriorated as regards the motor power. Improvement of the kyphotic and lordotic angles was evident in post-operative images. Eleven of our 15 cases (73%) improved to variable degrees, (from C to E Frankel grading); four patients had the same motor power as pre-operatively. Conclusion: It is possible to perform posterior surgical decompression and fusion augmented with internal fixation in thoracic & lumbar spondylodiscitis in one or more of the following: (1) those of high anesthetic risk for circumferential surgery, (2) kyphotic angel not more than 10º beyond the normal range in dorsal spine (3) the percentage of the anterior and posterior vertebral height is ≤ 30% (4) diminished or loss of lumbar lordosis, (5) average body weight. (2013ESJ046)

Keywords

• Spondylodiscits
• kyphosis
• internal fixation
• fusion