Study design: A single-institution, single-surgeon retrospective review.
Objective: To assess the efficacy of posterior only approach with short instrumentation and prolonged suction drainage in managing lumbar pyogenic spondylitis.
Summary of background data: Several methods of posterior surgical treatment for pyogenic spondylitis have been reported, there have been few reports regarding the efficacy of posterior only approach with short instrumentation including even inflamed segment.
Methods: Thirty-three patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with short instrumentation including the inflamed segment and catheter drainage were enrolled. Clinically infection control (erythrocyte sedimentation rate and C-reactive protein normalization time) and onset of ambulation were reviewed. Moreover, achievement of fusion and changes of sagittal alignment were investigated radiologically.
Results: In all 33 cases, infection was controlled successfully without any recurrence. There was no breakage of implant. Postoperative interval to normalization of erythrocyte sedimentation rate was average 69.4 days and C-reactive protein was 25.4 days, respectively. Ambulation was started at average 5.8 postoperative days. Successful interbody fusion was confirmed radiologically in all the cases at a mean of 5.4 months. Sagittal angle of fixed segment was average 6.9 degrees of lordosis before operation, which became more lordotic to 11.5 degrees just after operation, but decreased to 4.7 degrees of lordosis at the final follow up. Actually final sagittal alignment was almost same as preoperative status (P = 0.24).
Conclusion: By achieving favorable clinical and radiological results, short instrumentation and prolonged suction drainage with posterior only approach seemed to be an effective method in managing lumbar pyogenic spondylitis.
Level of evidence: 3.