Details

Autor(en) / Beteiligte

• von der Hoeh, Nicolas Heinz
• Voelker, Anna
• Hofmann, Alex
• Zajonz, Dirk
• Spiegl, Ulrich Albert
• Jarvers, Jan-Sven
• Heyde, Christoph-Eckhard

Titel

Pyogenic Spondylodiscitis of the Thoracic Spine: Outcome of 1-Stage Posterior Versus 2-Stage Posterior and Anterior Spinal Reconstruction in Adults

Ist Teil von

• World neurosurgery, 2018-12, Vol.120, p.e297-e303

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• The aim of this study was to compare the clinical, radiologic, and functional outcomes of a 1-stage posterior treatment versus a 2-stage posterior-anterior treatment in patients with pyogenic thoracic spondylodiscitis. A 1-stage posterior debridement, stabilization, and fusion with titanium-coated polyetheretherketone (PEEK) or mesh cage through a dorsolateral approach was performed in group A. A 2-stage procedure with initial posterior stabilization and debridement and second-stage fusion with a PEEK cage or mesh cage was performed with an anterior approach in group B. Clinical outcomes included Oswestry Low Back Pain Disability Questionnaire and visual analog scale score. Radiologic outcomes included fusion rate and kyphotic angle correction. Secondary variables included pathogens, complications, blood loss, and operative time. One-level spondylodiscitis was treated surgically in the thoracic spine of 47 patients: 25 patients in group A and 22 patients in group B. The most frequent segment was T12-L1 (27%). There was a significantly longer operative time and greater blood loss (P > 0.001) in group B. At last follow-up, sagittal profile reconstruction was significantly better (P > 0.05) in group B. Both groups showed similar radiologic results with fusion in 92% of cases. Improved clinical outcomes, pain, and quality of life were achieved in both groups with no significant differences between the 2 groups. Better reconstruction of the sagittal profile was achieved in the posterior-anterior–treated group, but this did not affect the clinical outcome. No significant differences were found in the clinical and functional outcomes between the 2 groups. Posterior-anterior combined treatment should be considered in cases of large anterior defects if a posterior reconstruction is inadequate. •A single-stage operation is as effective as a 2-stage operation with a shorter operative time and less blood loss.•A minimal better sagittal profile and less loss of reduction were achieved in the posterior-anterior–treated group.•A minimal better reconstruction of the sagittal profile and less loss of reduction was achieved in the posterior-anterior–treated group.•No significant differences were found in the clinical and functional outcomes between both groups.•Posterior-anterior treatment should be considered in large anterior defects when dorsal reconstruction is inadequate.