Anterior Spinal Fusion Using Autologous Bone Grafting via the Lateral Approach with Posterior Short-Range Instrumentation for Lumbar Pyogenic Spondylitis with Vertebral Bone Destruction Enables Early Ambulation and Prevents Spinal Deformity

Hidetoshi Nojiri; Takatoshi Okuda; Kei Miyagawa; Nozomu Kobayashi; Tatsuya Sato; Takeshi Hara; Yukoh Ohara; Kazuo Kaneko

doi:10.22603/ssrr.2020-0049

Anterior Spinal Fusion Using Autologous Bone Grafting via the Lateral Approach with Posterior Short-Range Instrumentation for Lumbar Pyogenic Spondylitis with Vertebral Bone Destruction Enables Early Ambulation and Prevents Spinal Deformity

Spine Surg Relat Res. 2020 Jun 18;4(4):320-327. doi: 10.22603/ssrr.2020-0049. eCollection 2020.

Authors

Hidetoshi Nojiri^{1

2}, Takatoshi Okuda^{1

2}, Kei Miyagawa^{1

2}, Nozomu Kobayashi^{1

2}, Tatsuya Sato^{1

2}, Takeshi Hara^{3

2}, Yukoh Ohara^{3

2}, Kazuo Kaneko^{1

2}

Affiliations

¹ Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan.
² Spine and Spinal Cord Center, Juntendo Hospital, Juntendo University School of Medicine, Tokyo, Japan.
³ Department of Neurosurgery, Juntendo University, Tokyo, Japan.

Abstract

Introduction: Pyogenic spondylitis of the lumbar spine markedly decreases the ability to perform activities of daily living and causes severe low back pain. The challenge is to improve low back pain and activities of daily living performance earlier and prevent post-infection sequelae, and conservative treatment with antibiotics is the mainstay of treatment.

Methods: In the present study, patients who were unable to walk following lumbar pyogenic spondylitis even in the subacute phase after successful infection control, showing bone defects expanding from endplate to vertebral body in CT, were treated with posterior percutaneous short-range instrumentation and anterior autogenous bone grafting (group S, n = 10) or with conservative treatment alone (group C, n = 10). Acute cases of absolute surgical indication with paralytic symptoms and mild cases who could walk by antibiotics administration were excluded. The two groups were compared regarding the post-treatment change in C-reactive protein level, duration of bed rest, and post-infection local spinal deformities (local scoliosis angle in the coronal plane and local kyphosis angle in the sagittal plane).

Results: Compared with group C, group S took a significantly shorter time for the C-reactive protein level to return to normal and required a significantly shorter duration of bed rest. Furthermore, surgery prevented the formation of kyphosis and scoliosis, while group C developed local kyphosis.

Conclusions: The minimally invasive surgical method of posterior percutaneous short-range instrumentation and anterior autogenous bone grafting effectively enables early control of pain and maintenance of locomotive function and prevents spinal deformity in patients with lumbar pyogenic spondylitis in the subacute phase with advanced vertebral bone destruction.

Keywords: activities of daily living; lateral retroperitoneal approach; low back pain; lumbar spine; minimally invasive surgery; pyogenic spondylitis; spinal deformity; surgical treatment.