L5/S1 pyogenic spondylodiscitis treated with anterior debridement and fusion combined with posterior fixation via Wiltse approach

English Keywords:One-stage anterior and posterior approach  Anterior of lumbar spine  Wiltse approach  Lumbar pyogenic spondylodiscitis

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy and clinical significance of one-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach for the treatment of L5/S1 pyogenic spondylodiscitis. Methods: Thirteen patients with L5/S1 pyogenic spondylodiscitis treated in our institution by one-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach from March 2011 to January 2014 were included, there were 8 males and 5 females． The ages of patients were from 28 to 60(41.6±11.0) years. The operation time, blood loss, postoperative complications, visual analogue scale(VAS) and lumbosacral angle(LSA) were recorded. Results: All patients were followed up for 6-30 months with an average time of 16.6±7.8 months． There were no severe complications during and after operation except of a case of retrograde ejaculation and deep venous thrombosis. The anterior operation time was 90.0±27.5 minutes in average(range, 70-120min), and the blood loss was 361.5±150.2ml in average(range, 200-600ml)． The posterior operation time was 57.7±8.3 minutes in average(range, 50-70min), and the blood loss was 106.9±56.9ml in average(range, 500-200ml)． According to the culture findings, there were 7 Staphylococcus aureus infections, 3 Escherichia coli infections, 1 Pseudomonas aeruginosa infection and negative in 2 cases. All patients reached clinical healing, no recurrence during follow-up was noted. The fusion rate was 100％ at postoperation． VAS was 7．8±0．7 at preoperation while 1．3±0．5 at 6 months of postoperation(P<0．05). The LSA was 4.4°±2.9° at preoperation, while it was 17.5°±2.8° at the final follow-up, the difference was statistically significant(P<0．05). Conclusions: One-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach is a safe and effective surgery in the treatment of L5/S1 pyogenic spondylodiscitis, it is with less surgery injury, easy operative procedure, reliable clinical results．