Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 9

Posterior Transpedicular Intercorporeal Impaction Morselized Bone Graft for the Treatment of Pyogenic Thoracolumbar Spondylodiscitis a Prospective Cohort Study

Mohamed Fawzy Khattab1*, Tameem Mohamed Elkhateeb1 and Youssry Elhawary2

1Department of Orthopedics and Spine Surgery, Ain Shams University, Cairo, Egypt
2Professor of Orthopedics and Spine Surgery, Cairo University, Cairo, Egypt

*Corresponding Author: Mohamed Fawzy Khattab, Department of Orthopedics and Spine Surgery, Ain Shams University, Cairo, Egypt.

Received: July 18, 2022; Published: August 12, 2022

Abstract

Study Design: Prospective cohort study.

Objectives: To assess the efficacy of transpedicular intercorporeal impaction morselized bone graft in management of pyogenic thoracolumbar spondylodiscitis.

Methods: Patients were treated from 2013 to 2020. All patients underwent transpedicular anterior column debridement, intercorporeal fusion using morselized bone graft with posterior pedicle screw fixation. Kirkcaldy-Willis criteria and the Visual analogue scale for back pain were used. Neurological state was assessed by recording ASIA scale. Radiological fusion was assessed by the Brantigan and Stefee grading system. The local kyphosis angle was assessed preoperatively, postoperatively and at final follow up. The presence of any complications was reported

Results: 38 patients met our inclusion criteria. Patients mean age 55.26 ± 7.41 SD years and mean follow up 42.12 ± 11.35 SD months. Preoperative VAS for back pain significantly improved. Kirkcaldy-Willis functional outcome were excellent in 26 patients, good in 9 patients and fair in 3 patients. All neurologically affected patients showed improvement of their neurological status. Radiologically intercorporeal bony fusion grade 4 and 5. Preoperative local kyphotic angle significantly improved from mean 22.73° ± 4.85 SD to 4.53 ° ± 2.35 SD postoperatively and 5.75° ± 1.66 SD at final follow up. No recurrence of infection, implant failure nor graft resorption.

Conclusion: Transpedicular debridement and impaction intercorporeal morselized bone graft is simple, safe, and cost-effective technique in treating thoracolumbar pyogenic spondylodiscitis. With good clinical and radiological outcomes.

 

Keywords: Spinal Infection; Impaction Morselized Bone Grafting; Posterior Spinal Approach; Transpedicular Intercorporeal Fusion

References

  1. Aljawadi A., et al. “Management of Pyogenic Spinal Infection, review of literature”. Journal of Orthopaedics 6 (2019): 508-512.
  2. Ryang YM and Akbar M. “Pyogenic spondylodiscitis: symptoms, diagnostics, and therapeutic strategies”. Orthopedics 8 (2020): 691-701.
  3. Butler JS., et al. “Nontuberculous pyogenic spinal infection in adults: a 12-years’ experience from a tertiary referral center”. Spine 32 (2006): 2695-2700.
  4. Elmajee M., et al. “Posterior stabilisation without formal debridement for the treatment of non-tuberculous pyogenic spinal infection in frail and debilitated population - A systematic review and meta-analysis”. Journal of Clinical Orthopaedics and Trauma 15 (2020): 9-15.
  5. Pola E., et al. “Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients”. European Spine Journal 2 (2018): s229-s236.
  6. Linhardt O., et al. “Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis”. International Orthopaedics 31 (2007): 113-119.
  7. Cheung YW., et al. “Pyogenic spondylitis”. International Orthopaedics 36 (2012): 397-404.
  8. Eysel P., et al. “Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study”. European Spine Journal 6 (2005): 152-157.
  9. Korovessis P., et al. “Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anaesthesia for septic spondylitis of thoracolumbear spine: is the use of titanium mesh cages safe?” Spine 31 (2006): 1014-1019.
  10. Lee JS and Suh KT. “Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis”. The Journal of Bone and Joint Surgery 88 (2006): 765-770.
  11. American Spinal injury Association. “Standards for Neurologic and functional classification of spinal cord injury”. Chicago, IL: ASIA (1992).
  12. Kirkadly-Willis WH., et al. “Lumbar spinal stenosis”. Clinical Orthopaedics 99 (1974): 30-50.
  13. Ha KY., et al. “The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumber spondylodiscitis”. Spine 32 (2007): 1856-1864.
  14. Brantigan JW and Steffee AD. “A carbon fiber implant to aid interbody fusion. Two-year clinical results in the first 26 patients”. Spine 18 (1993): 2106-2117.
  15. Sundararaj GD., et al. “Treatment of haematogenous pyogenic vertebral osteomyelitis by single-stage debridement, grafting of the defect, and posterior instrumentation”. The Journal of Bone and Joint Surgery 89 (2007): 1201-1205.
  16. Korovessis P., et al. “Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in haematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature”. Spine 33 (2008): E759-767.
  17. An KC., et al. “Posterior lumbar interbody fusion using compressive bone graft with allograft and autograft in pyogenic discitis”. Asian Spine Journal 1 (2012): 15-21.
  18. Lin CP., et al. “Surgical Results of Long Posterior Fixation With Short Fusion in the Treatment of Pyogenic Spondylodiscitis of the thoracic and lumbar spine”. Spine 37 (2012): E1572-E 1579.
  19. Deininger MH., et al. “Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis”. Acta Neurochirurgica 151 (2009): 1451-1457.
  20. Shetty AP., et al. “Pyogenic lumbar spondylodiscitis treated with transforamenal lumbar interbody fusion: safety and outcomes”. International Orthopaedics 40 (2016): 1163-1170.
  21. Gorensek M., et al. “Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine”. European Spine Journal 22 (2013): 633-641.
  22. Sundararaj GD., et al. “The use of titanium mesh cages in the reconstruction of anterior column defects in active spinal infections: can we rest the crest?” Asian Spine Journal 3 (2011): 155-161.
  23. Schomacher M., et al. “Application of titanium and polyetheretherketon cages for treating pyogenic spondylodiscitis”. Clinical Neurology and Neurosurgery 127 (2014): 65-70.
  24. Lv C., et al. “Comparative effectiveness of two different interbody fusion methods for transforamenal lumbar interbody fusion: cage versus morselized bone graft”. BMC Musculoskeletal Disorders Journal 16 (2015): 207.
  25. Lin TY., et al. “Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylitis”. BMC Musculoskeletal Disorders 15 (2014): 443.
  26. Gologoorsky Y., et al. “Increased incidence of pseudoarthrosis after unilateral instrumented transforamenal lumbar interbody fusion in patients with lumbar spondylosis”. Journal of Neurosurgery 21 (2014): 601-607.
  27. Ito Z., et al. “Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion”. Spine 35 (2010): E1101-1105.
  28. Hadjipavlou AG., et al. “Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis”. European Spine Journal 8 (2004): 707-713.
  29. Owens RK., et al. “Relative benefit of TLIF versus PSF stratified by diagnostic indication”. Journal of Spinal Disorders and Techniques 27 (2014): 144-147.
  30. Korovessis P., et al. “Mesh cage for treatment of hematogenous spondylodiscitis and spondylodiscitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade”. European Journal of Orthopaedic Surgery and Traumatology 26 (2016): 753-761.
  31. Kato S., et al. “The effect of spinal shortening after total en block spondylectomy”. Journal of Spinal Disorders 6 (2012): E183-E190.
  32. Halpern EM., et al. “Posterior transdiscal three-column shortening in the surgical treatment of vertebral discitis/osteomyelitis with collapse”. Spine 35 (2010): 1316-1322.

Citation

Citation: Mohamed Fawzy Khattab., et al. “Posterior Transpedicular Intercorporeal Impaction Morselized Bone Graft for the Treatment of Pyogenic Thoracolumbar Spondylodiscitis a Prospective Cohort Study". Acta Scientific Orthopaedics 5.9 (2022): 47-55.

Copyright

Copyright: © 2022 Mohamed Fawzy Khattab., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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