Extrafocal Percutaneous transpedicular fixation for the treatment of pyogenicspondyiscitis

IntroductionPyogenic spondylodiscitis (PS) is a challenging disease with poor prognosis thatrequires immediate diagnosis and treatment. It can be treated nonsurgically withantibiotics and immobilization with an external orthosis for several weeks to months. Ifsurgical intervention is required, a combined anterior and posterior approach is usuallyperformed. We report here on our experience with the use of minimally invasivepercutaneous transpedicular fixation (PTPF) for the treatment in patients with PS.MethodsWe reviewed data of 12 patients, between June 2013 and June 2017, treated forCongress of Iranian Orthopaedic Association58PS, without extensive bone destruction or significant neurological deficit, with PTPF.Demographic, operative, and perioperative data were collected and analysed.Results: Six females and six males with mean age of 75.9 years (90-57). Renalinsufficiency was found in 9 patients and DM in 5. Four cases were class II ASAScoreund 8 were class II and IV. Three patients suffered from a lumbar, three fromthoracolumbar, six from thoracic and four patients has multifocal PS (%33). Morethan three segments were fixed in six patients. The average operative time was 88minutes. The average blood loss was 160 ml. Intraop. biopsy for microbiological andhistopathological examination in 10 patients; organism could be isolated in 7 cases(%70). There were no intraop. complications, one patient died two days postop. due tocaradiac infarction. Three patients had been reoperated for shortening of the fixationafter fusion of the infected segments; occured in 9 patients within 6 months. Preop.VAS of 10/6 reduced to 2 at the last FU. Seven cases had ASIA-D, six improved postop.to ASIA-E with neurlogical improvement rate of %86. Preop. CRP and WBC were 83.2and 10.7 reduced to 32.5 and 8.8 at the last FU respectively.Conclusion : Long-term immobilization is critical, especially in elderly patients becauseof severe comorbidities. We present a minimally invasive surgical procedure to avoidimmobilization and to overcome the disadvantages of ventrodorsal procedure inpatients without significant neurological deficit or extensive bone destruction. Theinternal immobilization and antibiotic therapy without touching the infected tissueis sufficient to completely resolve the spondylodiscitis. Short and midterm outcomesare promising. A larger series and continuing follow-up examinations are necessary inorder to clarify and define benefits and limitations of the presented technique.