Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis.

Abstract

A retrospective clinical study investigated patients undergoing surgery for destructive pyogenic and tuberculous spondylodiscitis. To compare anterior debridement and bone grafting with a combined anterior and posterior procedure in terms of the physiologic alignment of the segmental sagittal spinal profile. There is considerable agreement in the literature on the indications for surgical treatment of destructive spondylodiscitis. An anterior approach usually is recommended for debridement and bone grafting. Additional posterior instrumentation is applied to reduce kyphotic deformities and to prevent a correction loss. No comparison has been made so far in the literature between repositioning results obtained after surgery for destructive spondylodiscitis and physiologic segmental sagittal angles. The surgical results of 49 patients treated by anterior debridement and bone grafting were compared with those of 22 patients who received additional posterior instrumentation. A comparison between the segmental kyphotic angles obtained and the standard values reported in the literature enabled an assessment of the segmental spinal alignment in the sagittal plane. Data were obtained from medical record review, imaging procedures, and patient follow-up examinations. All the subgroups submitted to a combined procedure had a greater preoperative segmental kyphosis angle than those undergoing anterior fusion alone. In marked segmental kyphotic false positioning, good postoperative repositioning was achieved by the combined procedure, and an increase in segmental kyphosis was permanently prevented. In single-level spondylodiscitis with no major substance loss, anterior debridement and bone grafting alone seem to be adequate, especially in the lumbar spine. Additional posterior instrumentation is indicated in multiple-level spondylodiscitis, extensive kyphotic deformity, or both.