Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis

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Abstract

Objective

To analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis.

Methods

A total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF.

Results

All of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8±1.1, which improved to 3.2±2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0±14.8, which improved to 34.2±27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic.

Conclusion

Our results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis.

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Most cited references 15

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Complication avoidance and management in anterior lumbar interbody fusion.

Khoi D. Than, Anthony C. Wang, Shayan Rahman … (2011)

The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.

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General principles in the medical and surgical management of spinal infections: a multidisciplinary approach.

Alfredo Quinones-Hinojosa, Peter Jun, Richard Jacobs … (2004)

Infections along the spinal axis are characterized by an insidious onset, and the resulting delays in diagnosis are associated with serious neurological consequences and even death. Infections of the spine can affect the vertebral bodies, intervertebral discs, spinal canal, and surrounding soft tissues. Neurological dysfunction occurs when the spinal cord becomes compressed, edematous, or ischemic due to compression by abscess or vascular compromise. The aim of this paper was to detail general diagnostic and management principles for this disease. Recent progress in medical technologies, including the development of potent antimicrobial drugs, advanced imaging, and improved surgical methods, have dramatically reduced morbidity and mortality rates for spinal infections; however, debate still exists on the proper management of this disease. In this paper, the authors review the current management protocols for spinal infections at their institution, focusing on medical and surgical treatments for vertebral osteomyelitis, intervertebral disc space infections, and spinal canal and soft-tissue abscesses. Technological advances in imaging modalities, pharmaceutics, and surgery have resulted in excellent outcomes and have greatly reduced the morbidity and mortality rates associated with spinal infections. Currently, treatment of spinal infections requires a multidisciplinary team that includes infectious diseases experts, neuroradiologists, and spine surgeons. The key to successful management of spinal infections is early detection.

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Comparative study of postoperative and spontaneous pyogenic spondylodiscitis.

Laurence Le Moyec, Nadia Belmatoug, Ludovic Rillardon … (2005)

Postoperative spondylodiscitis (POS) is poorly characterized, partly owing to its rarity. The aim of this prospective study was to compare the clinical, biological, bacteriological, and imaging features of postoperative and spontaneous spondylodiscitis (SS). A multidisciplinary spondylodiscitis cohort follow-up study was conducted between February 1999 and June 2003 in a 500-bed teaching hospital. All patients hospitalized in internal medicine, orthopedic, and neurosurgery wards with a culture-proven diagnosis of pyogenic spondylodiscitis were included. Clinical and bacteriological data were collected. All patients underwent computed tomography and/or magnetic resonance imaging of the spine. Sixteen patients had SS and 7 patients had POS. Patients with POS tended to be younger (52 versus 69 years), with less frequent underlying diseases (29 versus 75%) and a more prolonged interval between symptom onset and diagnosis (16 versus 3.4 weeks) than patients with SS. Blood cultures were positive in 14 and 81% of cases in the POS and SS groups, respectively, and invasive diagnostic procedures were necessary in 86% of patients with POS and 19% of patients with SS ( P = 0.005). Staphylococci were the more frequent isolates in both groups but were more frequently coagulase-negative in POS patients than in patients with SS ( P = 0.01). Vertebral edema tended to be more frequent in POS and was located more posteriorly than in SS ( P = 0.023). POS is associated with specific clinical, microbiological, and imaging features possibly related to pathophysiologic characteristics. Knowledge of these characteristics should help reduce the current delay in the diagnosis of POS.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Neurosurg Soc

Journal ID (iso-abbrev): J Korean Neurosurg Soc

Journal ID (publisher-id): JKNS

Title: Journal of Korean Neurosurgical Society

Publisher: The Korean Neurosurgical Society

ISSN (Print): 2005-3711

ISSN (Electronic): 1598-7876

Publication date (Print): October 2014

Publication date (Electronic): 31 October 2014

Volume: 56

Issue: 4

Pages: 310-314

Affiliations

Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.

Author notes

Address for reprints: Sung-Uk Kuh, M.D., Ph.D. Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 712 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2-2019-3404, Fax: +82-2-3461-9229, kuhsu@ 123456yuhs.ac

Article

DOI: 10.3340/jkns.2014.56.4.310

PMC ID: 4219188

SO-VID: 5265999e-7d0a-4442-8918-34ac9737c0b3

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 05 May 2014

Date revision received : 04 September 2014

Date accepted : 18 September 2014

Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis

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Abstract

Objective

Methods

Results

Conclusion

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Karger: Gastroenterology

Most cited references 15

Complication avoidance and management in anterior lumbar interbody fusion.

General principles in the medical and surgical management of spinal infections: a multidisciplinary approach.

Comparative study of postoperative and spontaneous pyogenic spondylodiscitis.

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