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Transpedicular curettage and drainage of infective lumbar spondylodiscitis: technique and clinical results.

Authors
 Byung Ho Lee  ;  Hwan-Mo Lee  ;  Tae-Hwan Kim  ;  Hak-Sun Kim  ;  Eun-Soo Moon  ;  Jin-Oh Park  ;  Hyun-Soo Chong  ;  Seong-Hwan Moon 
Citation
 CLINICOECONOMICS AND OUTCOMES RESEARCH, Vol.4(3) : 200-208, 2012 
Journal Title
 CLINICOECONOMICS AND OUTCOMES RESEARCH 
ISSN
 2005-291X 
Issue Date
2012
MeSH
Aged ; Bone Screws ; Curettage/methods* ; Discitis/blood ; Discitis/microbiology ; Discitis/surgery* ; Drainage/methods* ; Female ; Humans ; Inflammation/blood ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Tuberculosis, Spinal/blood ; Tuberculosis, Spinal/microbiology ; Tuberculosis, Spinal/surgery
Keywords
Curettage ; Drainage ; Spondylodiscitis ; Surgery ; Transpedicular
Abstract
BACKGROUND: Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, co-morbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method is needed for these select cases of infective spondylodiscitis. This retrospective clinical case series reports our novel surgical technique for the treatment of infective spondylodiscitis. METHODS: Between January 2005 and July 2011, among 48 patients who were diagnosed with pyogenic lumbar spondylodiscitis or tuberculosis lumbar spondylodiscitis, 10 patients (7 males and 3 females; 68 years and 48 to 78 years, respectively) underwent transpedicular curettage and drainage. The mean postoperative follow-up period was 29 months (range, 7 to 61 months). The pedicle screws were inserted to the adjacent healthy vertebrae in the usual manner. After insertion of pedicle screws, the drainage pedicle holes were made through pedicles of infected vertebra(e) in order to prevent possible seeding of infective emboli to the healthy vertebra, as the same instruments and utensils are used for both pedicle screws and the drainage holes. A minimum of 15,000 mL of sterilized normal saline was used for continuous irrigation through the pedicular pathways until the drained fluid looked clear. RESULTS: All patients' symptoms and inflammatory markers significantly improved clinically between postoperative 2 weeks and postoperative 3 months, and they were satisfied with their clinical results. Radiologically, all patients reached the spontaneous fusion between infected vertebrae and 3 patients had the screw pulled-out but they were clinically tolerable. CONCLUSIONS: We suggest that our method of transpedicular curettage and drainage is a useful technique in regards to the treatment of infectious spondylodiscitic patients, who could not tolerate conventional combined anterior and posterior surgery due to multiple co-morbidities, multiple level infectious lesions and poor general condition.
Files in This Item:
T201202900.pdf Download
DOI
22949951
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hwan(김태환)
Kim, Hak Sun(김학선) ORCID logo https://orcid.org/0000-0002-8330-4688
Moon, Seong Hwan(문성환)
Moon, Eun Su(문은수)
Park, Jin Oh(박진오)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
Chong, Hyon Su(정현수)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90052
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