Introduction: The lumbar spine is the most common location of pyogenic spine infection (50%). Goals of surgery are: to eradicate infection, relieve pain, preserve or improve neurological functions and spinal alignment and to allow early mobilisation. Aim of this study was to compare a combined
approach for anterior debridement, fusion and posterior stabilisation (AD-PS) to posterior lumbar interbody fusion (PLIF) in cases without severe bony destruction and without psoas abscess. Material and Methods: A retrospective study comparing both surgical techniques as regards operative time, blood loss, exposure to radiation, complication rate, loss of correction and clinical outcome. All PLIF cases meeting those criteria and operated between 1996 and 2011, and all AD-PS cases since 2006 with a minimum follow-up (FU) of six months were included. The statistical significance was assessed using independent-samples t test. In qualitative variables we used Pearson’s chi square test (X2).
Results: In group A, 30 cases were operated with PLIF technique; 16 males and 14 females, with a mean age of 56.3 years, mean operative time of 160.7 minutes, mean radiation exposure of 16.87 seconds, average blood loss of 991.7 mL and mean FU of 46.3 months. Four patients needed reoperation (13.3%). At the end of FU, mean loss of correction was 4.75°. Fusion was achieved in 29 patients (96.7%). The final outcome was excellent in nine patients (30%), good in 11 (36.7%), fair in seven (23.3%) and poor in three (10%). Intraoperative complications: dural tears in four (13.3%), bleeding (≥2000 mL) in two cases, screw misplacement in one case and segmental kyphosis in one case. Late complications: recurrence in one case, adjacent segment decompensation (ASD) in one case, correction loss (≥ 10°) in three cases (10%), non union in one case. In group B, 33 cases were operated with AD-PS; 18 males and 15 females, with a mean age of 64.5 years, mean operative time of 244.4 minutes, mean radiation exposure of 238.3 seconds, average blood loss of 830.3 mL and mean FU of 17.9 months. Five patients needed reoperation (15.2%). At the end of FU, mean segmental loss of correction was 6.52°. Fusion was achieved in all patients. The final outcome was excellent in 11
(33.3%), good in 12 (36.4%), fair in seven (21.2%) and poor in three patients (9.1%). Intraoperative complications: screw/cage
displacement in two, bleeding in three patients (one common iliac vein injury). Late complications: recurrence in one case, ASD in one case, correction loss (≥10°) in three cases (9.1%). PLIF technique was significantly advantageous as regards operative time and radiation exposure (p>0.05). No significant difference was found regarding the degree of loss of segmental or total lumbar correction at the end of FU (p>0.05). There was no significant difference in complication rate or reoperation rate (p>0.05).
Conclusion: Both techniques are comparable in clinical outcomes and complication rates. AD-PS seems less invasive avoiding the risk of dural tear, thus providing a sufficient surgical solution in infections with massive bony destruction and those associated with psoas abscess (and intraspinal abscess), despite its higher exposure to radiation and longer operative time. Both techniques offer a lesser invasive option for polymorbid and elderly patients that might not be otherwise operable. |
