Surgical results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study.

STUDY DESIGN: A single-institution, single-surgeon retrospective review.

OBJECTIVE: To evaluate the clinical results of long posterior instrumentation with short posterior or posterolateral fusion for pyogenic spondylodiscitis of the thoracic and lumbar spine retrospectively.

SUMMARY OF BACKGROUND DATA: There are controversies concerning the optimal treatment for pyogenic spondylodiscitis, in terms of approach, grafting, and instrumentation. Reports of long posterior fixation with short fusion without debridement of infected tissue for pyogenic spondylodiscitis are rare.

METHODS: From June 1997 to June 2007, 48 patients with pyogenic spondylodiscitis were treated. The indications for surgery were neurological compromise, significant vertebral body destruction with kyphosis and segmental instability, failure of medical treatment, and the need for tissue diagnosis. All patients received long posterior instrumentation with or without posterior decompression, depending on whether the patients had neurological deficit. During operation, no debridement of infected tissue was done. Clinical outcomes were assessed using the criteria of Kirkaldy-Willis and the visual analogue scale for pain. The neurological outcome was graded using Frankel grading system. Segmental kyphotic angle and fusion were recorded and analyzed.

RESULTS: The average follow-up time was 64 months. The visual analogue scale scores improved from an average of 7.2 before surgery to 2.2 after surgery. Twenty-eight patients with initial neurological impairment had an average improvement of 1.03 grades, using the Frankel grading system, at the final follow-up. The segmental kyphotic deformity improved by an average of 8.5° immediately after operation and lost an average correction of 3.0° at the final follow-up. No relapse of infection was found among these 48 patients.

CONCLUSION: The posterior approach with long segmental fixation and short posterior or posterolateral fusion without debridement of the infected tissue was effective for pyogenic spondylodiscitis of the thoracic and lumbar spine.