PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis-A Single-Center Retrospective Study of 73 Cases

Moritz Caspar Deml; Emmanuelle N Cattaneo; Sebastian Frederick Bigdon; Hans-Jörg Sebald; Sven Hoppe; Paul Heini; Lorin Michael Benneker; Christoph Emanuel Albers

doi:10.3390/bioengineering9020073

PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis-A Single-Center Retrospective Study of 73 Cases

Bioengineering (Basel). 2022 Feb 15;9(2):73. doi: 10.3390/bioengineering9020073.

Authors

Moritz Caspar Deml¹, Emmanuelle N Cattaneo¹, Sebastian Frederick Bigdon¹, Hans-Jörg Sebald², Sven Hoppe¹, Paul Heini³, Lorin Michael Benneker^{1

3}, Christoph Emanuel Albers¹

Affiliations

¹ Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, Switzerland.
² Department of Orthopaedic and Spine Surgery, Spital Thun, 3600 Thun, Switzerland.
³ Department of Orthopaedic and Spine Surgery, Sonnenhof Spital, University Bern, 3006 Bern, Switzerland.

Abstract

Background: Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is often impossible. Therefore, we developed the "Cement-PLIF", a single-stage posterior lumbar procedure, combining posterior lumbar interbody fusion (PLIF) with defect-filling using antibiotic-loaded polymethylmethacrylate (PMMA). This study first describes and evaluates the procedure's efficacy, safety, and infection eradication rate. Radiological implant stability, bone-regeneration, sagittal profile reconstruction, procedure-related complications, and pre-existing comorbidities were further analyzed.

Methods: A retrospective cohort study analyzing 73 consecutive patients with a minimum of a one-year follow-up from 2000-2017. Patient-reported pain levels and improvement in infectious serological parameters evaluated the clinical outcome. Sagittal profile reconstruction, anterior bone-regeneration, and posterior fusion were analyzed in a.p. and lateral radiographs. A Kaplan-Meier analysis was used to determine the impact of pre-existing comorbidities on mortality. Pre-existing comorbidities were quantified using the Charlson-Comorbidity Index (CCI).

Results: Mean follow-up was 3.3 (range: 1-16; ±3.2) years. There was no evidence of infection persistence in all patients at the one-year follow-up. One patient underwent revision surgery for early local infection recurrence (1.4%). Five (6.9%) patients required an early secondary intervention at the same level due to minor complications. Radiological follow-up revealed implant stability in 70/73 (95.9%) cases. Successful sagittal reconstruction was demonstrated in all patients (p < 0.001). There was a significant correlation between Kaplan-Meier survival and the number of pre-existing comorbidities (24-months-survival: CCI ≤ 3: 100%; CCI ≥ 3: 84.6%; p = 0.005).

Conclusions: The Cement-PLIF procedure for pyogenic erosive spondylodiscitis is an effective and safe treatment as evaluated by infection elimination, clinical outcome, restoration, and maintenance of stability and sagittal alignment.

Keywords: PMMA; bony erosion; discitis; osteomyelitis; polymethylmethacrylate; spinal implants; spinal infection; spine; spondylodiscitis; staphylococcus aureus.