Anterior Surgery With Insertion of Titanium Mesh Cage and Posterior Instrumented Fusion Performed Sequentially on the Same Day Under One Anesthesia for Septic Spondylitis of Thoracolumbar Spine
| Autor: | Georgios Petsinis, Georgios Koureas, Spyridon Zacharatos, Panagiotis Korovessis, Panagiotis Iliopoulos |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal Hernia Thoracic Vertebrae Central nervous system disease Anti-Infective Agents Ciprofloxacin Sepsis Humans Medicine Orthopedics and Sports Medicine Spondylitis Aged Retrospective Studies Aged 80 and over Titanium Lumbar Vertebrae business.industry Osteomyelitis Retrospective cohort study Prostheses and Implants Middle Aged Surgical Mesh medicine.disease Rifamycins Internal Fixators Sagittal plane Surgery Spinal Fusion Treatment Outcome medicine.anatomical_structure Anesthesia Female Intractable pain Neurology (clinical) business Complication |
| Zdroj: | Spine. 31:1014-1019 |
| ISSN: | 0362-2436 |
| DOI: | 10.1097/01.brs.0000215049.08622.9d |
| Popis: | Study design Retrospective study. Objective To evaluate the outcome on patients with pyogenic spondylitis of the thoracolumbar spine following combined anterior and posterior surgery. Summary and background data Several methods of surgical treatment of pyogenic spondylitis have been reported. These include anterior approach, staged and simultaneous anterior decompression, and posterior stabilization. The use of anterior implants in the presence of an infection presents a challenge for spine surgeons. This study analyzes the clinical and radiologic outcome of surgical intervention on patients with pyogenic spondylitis of the thoracolumbar spine who were treated surgically for intractable pain, instability, and neurologic impairment. Methods Fourteen patients (6 women, 8 men) with thoracolumbar spondylitis were treated with anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The age (average, SD) of the patients at the time of surgery was 55 +/- 16 years (range, 29-83 years). Most patients had also systemic diseases as lung tuberculosis, hepatic cirrhosis, diabetes mellitus, or chronic renal failure. Patients were evaluated before and after surgery in terms of pain, neurologic level, sagittal spinal balance, and radiologic fusion. Results The average duration of the combined surgery was 4.5 hours. All patients were observed up for an average of 45 months (range, 37-116 months). The Visual Analog Scale score (average, range) improved from 7 (range, 4-10) before surgery to 2 (range, 0-5) after surgery. Correction (average, range) of segmental kyphotic deformity was 6 degrees (range, 0 degrees-11 degrees) without loss of correction at the final observation. Neither a postoperative change of the position of mesh cage nor any posterior instrumentation failure was recorded. Patients with incomplete neurologic impairment showed improvement after surgery at an average 1.4 Frankel's grade. There was one complication, an anterior wound abscess culminating in an abdominal hernia. Conclusions This clinical study showed that patients with thoracolumbar osteomyelitis can successfully undergo anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The presence of the mesh cage anteriorly at the site of spondylitis had no negative influence on the course of infection healing, and additionally it stabilized the affected segment maintaining sufficient sagittal profile. |
| Databáze: | OpenAIRE |
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