Skip to main content
SpringerLink
Log in

Operative treatment of spondylodiscitis —what is the most effective approach?

  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

In a study the results recorded in 34 surgically treated patients with specific or unspecific spondylodiscitis after dorsoventral one-stage instrumentation with CDI and anterior grafting (group 1) were compared with those obtained in a group of 38 patients treated with anterior CDH instrumentation in combination with anterior grafting (group 2). The mean observation periods were 48.4 (19–82) months in group 1 and 29.0 (8–54) months in group 2. In both groups the infection healed after fusion without a secondary operation. In group 1 the mean values for blood loss, operating time, length of hospital stay and fusion length (3.5 segments) were significant higher than those in group 2; in particular, the fusion length was shorter (1.3 segments) in group 2. Only 8 patients in group 1 were treated with postoperative external support. The mean preoperative segmental angle of 18.2° (group 1) was corrected by a mean of 11.9°, and the reposition loss during follow-up amounted to an average of 2.7°. Group 2 showed a mean preoperative segmental deformity angle of 13.4°, which was corrected by 11.6°, and the loss of reposition was 2.9° on average. Even in florid spondylodiscitis a short-range anterior fusion of the affected spinal segment can be performed with a primarystable implant, avoiding a second operation without an increased risk of infection-related dislocation. In the authors' own experience a secondary dorsal operation can be avoided except in the case segment L-5/S-1, the fast mobilization without external support allows a up-to-date treatment in this severe spinal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aliabadi, H, C Johnson, AS Cass, J Mayfild, K Vandenerink: Ureteral obstruction following the Dwyer procedure in a patient with an ileal loop urinary diversion. Spine 9 (1984) 819–821

    Google Scholar 

  2. Brown LP, KH Bridwell, RT Holt, J Jennings: Aortic erosion and laceration associated with the Dunn anterior spinal instrumentation. Orthop Trans 10 (1986) 16–17

    Google Scholar 

  3. Brussatis F, H Blümlein, TW Underlich: Ergebnisse nach Ausräumung und Fusion bei Spondylitiden. Z Orthop 121 (1983) 458–459

    Google Scholar 

  4. Buchner H, P Pink: Die Spondylitis tuberculosa. Orthopäde 10 (1981) 119–132

    Google Scholar 

  5. Chan FL, SP Chow: Retroperitoneal fibrosis after anterior spinal fusion. Clin Radiol 34 (1983) 331–335

    Google Scholar 

  6. Cleveland RH, V Gilsanz, RL Lebowitz, RH Wilkinson: Hydronephrosis from retroperitoneal fibrosis after anterior spine fusion J Bone Joint Surg [Am] 60a (1978) 996–997

    Google Scholar 

  7. Collert S: Osteomyelitis of the spine. Acta Orthop Scand 48 (1977) 283–290

    Google Scholar 

  8. Colton CL, AJ Hall: Atlas of orthopaedic surgical approaches. Butterworth-Heinemann, Stoneham 1991

    Google Scholar 

  9. Costerton JW, RT Irvin, KJ Cheng: The bacterial glycocalyx in nature and disease. Annu Rev Microbiol 35 (1981) 299–324

    Google Scholar 

  10. Dick W, R Graf, E Morscher: Konservative und operative Therapie der Spondylitis. Therapiewoche 34 (1984) 448–152

    Google Scholar 

  11. Digby JM, JB Kersley: Pyogenic non-tuberculoss spinal infection. J Bone Jt Surg [Br] 61b (1979) 47–55

    Google Scholar 

  12. Dufek P, G Salis-Soglio Frhr von, Z Bozdech: Die unspezifische bakterielle Spondylitis — eine Analyse von 32 Fällen. Z Orthop 125 (1987) 225–261

    Google Scholar 

  13. Dunn HK: Anterior stabilisation of thoracolumbar injuries. Clin Orthop 189 (1984) 116–124

    Google Scholar 

  14. Dunn HK: Anterior spine stabilization and decompression for thoracolumbar injuries. Orthop Clin North Am 17 (1986) 113–119

    Google Scholar 

  15. Dunn HK, AU Daniels, GG McBride: Comparative assessment of spine stability achieved with a new anterior spine fixation system. Orthop Trans 4 (1980) 268–269

    Google Scholar 

  16. Dunn HK, EM Globe, GG McBride, AU Daniels: An implant system for anterior spine stabilization. Orthop Trans 5 (1981) 433–434

    Google Scholar 

  17. Dwyer AF, AC Yau, L Hsu, JP O'Brien, AR Hodgson: Deep paravertebral infection following Dwyer anterior spinal instrumentation. A report of three cases. Spine 1 (1976) 201–206

    Google Scholar 

  18. Eichenauer M, EO van der Lan, A Mostegl: Vorwiegend ambulant-konservative Behandlung der unkomplizierten Spondylitis tuberculosa. Therapiewoche 37 (1987), 122–131

    Google Scholar 

  19. Eismont FJ, HH Bohlman, PL Soni, VM Goldberg, AA Freehafer: Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Jt Surg [Am] 65a (1983) 19–29

    Google Scholar 

  20. Enderle A, E Schmitt, L Zichner: Zur Diagnostik herdförmiger Wirbelsäulenerkrankungen — eine kritische Betrachtung. Z Orthop 119 (1981) 193–205

    Google Scholar 

  21. Eysel P, C Hopf, A Diop, F Lavaste: Die mehrsegmentale ventrale Stabilisierung der Lendenwirbelsäule: eine vergleichende biomechanische Studie. Z Orthop 133 (1995) 242–248

    Google Scholar 

  22. Flynn JC, CT Price: Sexual complications of anterior fusion of the lumbar spine. Spine 9 (1984) 489–492

    Google Scholar 

  23. Giehl JP, K Zielke, HP Hack: Die ventrale Derotationsspondylodese Bach Zielke. Orthopäde 18 (1989) 101–117

    Google Scholar 

  24. Gristina AG, JW Costerton: Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 15 (1985) 517–535

    Google Scholar 

  25. Gristina AG, M Oga, LX Webb, DC Hobgood: Bacterial adherence and the pathogenesis of osteomyelitis. Science 228 (1985) 990–993

    Google Scholar 

  26. Harmon PH: A simplified surgical technic for anterior lumbar discectomy and fusion. Avoidance of complications. Anatomy of the retroperitoneal veins. Clin Orthop 37 (1964) 130–144

    Google Scholar 

  27. Heine J, M Immenkamp, HH Matthiass: Ergebnisse der operativen Behandlung der Spondylitis tuberculosa. Z Orthop 121 (1983) 457–461

    Google Scholar 

  28. Hodgson AR, FE Stock: Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Jt Surg [Am] 42a (1960) 295–310

    Google Scholar 

  29. Hope C, P Eysel, J Dubousset: CDH preliminary report on a new anterior spinal instrumentation. Eur Spine J 4 (1995) 194–199

    Google Scholar 

  30. Ito H, J Tsuchiy, G Asami: A new radical operation for Potts disease. J Bone Jt Surg 16 (1934) 499–511

    Google Scholar 

  31. Jäger M, HH Springer: Die entzündlichen Erkrankungen der Wirbelsäule. Orthopäde 10 (1981) 106–113

    Google Scholar 

  32. Jendrisak MD: Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device. A case report. Surgery 99 (1986) 631–633

    Google Scholar 

  33. Johnson RM, EJ McGuire: Urogenital complications of anterior approaches to the lumbar spine. Clin Orthop 154 (1981) 114–118

    Google Scholar 

  34. Kaneda K: Anterior approach and Kaneda instrumentation for lesions of the thoracic and lumbar spine. In:Bridwell KH, RL Dewald (eds.): Textbook of spinal surgery. Lippincott, Philadelphia, 1981

    Google Scholar 

  35. Kemp HBS, JW Jackson, JD Jeremiah, AJ Hall: Pyogenic infections occurring primarily in intervertebral discs. J Bone Jt Sung [Br] 55b (1973) 699–714

    Google Scholar 

  36. Kemp HBS, JW Jackson, JD Jeremiah, J Cook: Anterior fusion of the spine for infective lesions in adults. J Bone Jt Surg [Br] 55b (1973) 715–734

    Google Scholar 

  37. King DM, KM Mayo: Infective lesion of the vertebral column. Clin Orthop 96 (1973) 248–253

    Google Scholar 

  38. Kirkaldy-Willis WH, TG Thomas: Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. J Bone Jt Surg [Am] 47a (1965) 87–110

    Google Scholar 

  39. Krödel A, H Stürz: Differenzierte operative und konservative Therapie der Spondylitis und Spondylodiscitis. Z Orthop 127 (1989) 587–596

    Google Scholar 

  40. La Rocca H: Infections of the spine. Clin Neurosurg 25 (1978) 296–304

    Google Scholar 

  41. Leong JCY: Anterior spinal fusion for low back syndrome. In:Floman Y (ed): Disorders of lumbar spine, Aspen, Gaithersburg, Md 1990

    Google Scholar 

  42. Lifeso RM, P Weaver, EH Harder: Tuberculous spondylitis in adults. J Bone Joint Surg [Am] 67a (1985) 1405–1413

    Google Scholar 

  43. Manner G, K Parsch: Spondylitis und Spondylodiszitis beim Kind. Z Orthop 121 (1983) 455–456

    Google Scholar 

  44. Martin NS: Tuberculosis of the spine. J Bone Jt Surg [Br] 52b (1970) 613–621

    Google Scholar 

  45. McMaster WC, I Silber: An urological complication of Dwyer instrumentation. J Bone Joint Surg [Am] 57a (1975) 710–711

    Google Scholar 

  46. Medical Research Council Working Party on Tuberculosis of the Spine: A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. J Bone Surg [Br] 67b (1985) 103–110

  47. Meurer A, P Eysel, J Heine: Ergebnisse der operativen Behandlung der Spondylitis tuberculosa. Z Orthop 133 (1995) 227–23

    Google Scholar 

  48. Nasca JR, RB McElvein: Aspergillus fumigatus osteomyelitis of the thoracic spine treated by excision and interbody fusion. Spine 10 (1985) 848–851

    Google Scholar 

  49. Oga M, Y Sugioka, CD Hobgood, AG Gristina, QN Myrvik: Surgical biomaterials and differential colonization byStaphylococcus epidermidis. Biomaterials 9 (1988) 285–289

    Google Scholar 

  50. Oga M, T Arizono, M Takasita, Y Sugioka: Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine 18 (1993) 1890–1894

    Google Scholar 

  51. Parthasarathy R: Madras study of tuberculosis of spine. Assessment and follow-up. In: Shanmugasundaram TK (ed): Current concepts in bone and joint tuberculosis. International Bone and Joint Tuberculosis Club, Madras, 1985

    Google Scholar 

  52. Peters KM, B Schwanitz, KW Zilkens: Spondylodiszitis — eine häufig spät gestellte Diagnose. Orthop Praxis 28 (1992) 108–112

    Google Scholar 

  53. Rajasekaran S, TK Shanmugasundaram: Prediction of the angle of Gibbus deformity in tuberculosis of the spine. J Bone Jt Surg [Am] 69 (1987) 503–509

    Google Scholar 

  54. Rajasekaran S, S Soundarapandian: Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Jt Surg [Am] 71a (1989) 1314–1323

    Google Scholar 

  55. Robinson BHB, MHJ Lessof: Osteomyelitis of the spine. Guys Hosp Rep 110 (1972) 303–309

    Google Scholar 

  56. Schulze W: Entzündliche Wirbelsäulenprozesse. Die Wirbelsäule in Forschung und Praxis 83 (1979) 147–150

    Google Scholar 

  57. Silber I, W McMaster: Retroperitoneal fibrosis with hydronephrosis as a complication of the Dwyer procedure. J Pediatr Surg 12 (1977) 255–257

    Google Scholar 

  58. Stevenson FH, CW Manning: Tuberculosis of the spine treated conservatively with chemotherapy. Tubercle 43 (1962) 406–410

    Google Scholar 

  59. Stolke D, V Seifert, U Kunz: Die postoperative Discitis intervertebralis lumbalis. Z Orthop 126 (1988) 666–670

    Google Scholar 

  60. Wedge JH, AF Oryschak, DE Robertson, WH Kirkaldy-Willis: Atypical manifestations of spinal infections. Clin Orthop 123 (1977) 155–263

    Google Scholar 

  61. Woolsey RM: Aortic laceration after anterior spinal fusion. Surg Neurol 25 (1986) 267–268

    Google Scholar 

  62. Zielke K: Ventrale Derotationsspondylodese — Irrtümer und Ergebnisse nach vier Jahren. Z Orthop 118 (1980) 626

    Google Scholar 

  63. Zielke K: Ventrale Derotationsspondylodese, Behandlungsergebnisse bei idiopathischen Lumbalskoliosen. Z Orthop 120 (1982) 320–329

    Google Scholar 

  64. Zielke K, R Stunkat, F Beaujean: Ventrale Derotationsspondylodese. Vorläufiger Ergebnisbericht über 26 operierte Fälle. Arch Orthop Unfallchir 85 (1976) 257–277

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lubinus Klinik Kiel, Steenbeker Weg 25, D-24106, Kiel, Germany

    C. Hopf, A. Meurer, P. Eysel & J. D. Rompe

Authors
  1. C. Hopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Meurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Eysel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. D. Rompe
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hopf, C., Meurer, A., Eysel, P. et al. Operative treatment of spondylodiscitis —what is the most effective approach?. Neurosurg. Rev. 21, 217–225 (1998). https://doi.org/10.1007/BF01105775

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01105775

Keywords

Search

Navigation