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J Neurol Surg A Cent Eur Neurosurg 2023; 84(01): 03-07
DOI: 10.1055/a-1832-9092
Original Article

The Role of Diskectomy in Reducing Infectious Complications after Surgery for Lumbar Spondylodiscitis

Bawarjan Schatlo 
1   Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
,
Veit Rohde
1   Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
,
Tammam Abboud
1   Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
,
Insa Janssen
2   Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany
3   Department of Neurosurgery, Faculté de Médecine, University Hospital Geneva, Geneva, Switzerland
,
Patrick Melich
4   Department of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Bernhard Meyer 
2   Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany
,
Ehab Shiban 
2   Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany
5   Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
› Author Affiliations Funding None.
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Abstract

Background Surgery for pyogenic Spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate diskectomy in all cases. Others maintain that stand-alone instrumentation is sufficient.

Methods We reviewed charts of patients who underwent instrumentation for pyogenic Spondylodiscitis with a minimum follow-up of 1 year. Patients were stratified according to whether they underwent diskectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision, and construct failure.

Results In all, 257 patients who underwent surgery for pyogenic Spondylodiscitis were identified. Diskectomy and interbody procedure (group A) was performed in 102 patients, while 155 patients underwent instrumentation surgery for Spondylodiscitis without intradiskal debridement (group B). The mean age was 67 ± 12 years, and 102 patients (39.7%) were females. No significant differences were found in the need for epidural abscess recurrence therapy (group A [2.0%] and 5 cases in group B [3%; p = 0.83]) and construct failure (p = 0.575). The need for wound revisions showed a tendency toward higher rates in the posterior instrumentation–only group, which failed to reach significance (p = 0.078).

Conclusions Overall, intraspinal relapse of surgically treated pyogenic diskitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no diskectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population.

Keywords

spine Instrumentation - Spondylodiscitis - spine surgery - spinal fusion - vertebral osteomyelitis


Publication History

Received: 31 December 2021

Accepted: 19 April 2022

Accepted Manuscript online:
22 April 2022

Article published online:
05 January 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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