Sang Bum Chang1, Sang-Ho Lee2, Won Joong Kim1

1Departments of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Korea
2Departments of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea

Keywords: Bacterial infections; bone screws; bone transplantation; intervertebral disk displacement/surgery; lumbar vertebrae/surgery; osteomyelitis/etiology/surgery; postoperative complications.


Objectives: Lumbar pyogenic spondylodiscitis is a serious complication after microdiscectomy. A new surgical technique is described for its treatment and preliminary results are presented.
Patients and methods: Four consecutive patients (3 men, 1 woman; mean age 60 years; range 47 to 75 years) with pyogenic spondylodiscitis secondary to microdiscectomy were treated with anterior fusion with the Chuinard & Peterson type bone graft and percutaneous facet screw fixation. All the patients had infection of the deep anterior column, which was associated with posterior soft tissue infection from a previous wound. The mean time interval between microdiscectomy and fusion was 2.4 months (range 6 weeks to 4 months). An autoiliac tricortical bone graft was used according to the Chuinard & Peterson technique for anterior fusion, followed by percutaneous facet screw fixation. The mean follow-up period was 11 months (range 5 to 17 months).
Results: The mean operation time and blood loss were 207 minutes (range 150 to 285 min) and 900 ml (range 500 to 2000 ml), respectively. The only complication was an avulsion fracture in the anterior ilium. C-reactive protein levels decreased by 50% after an average of two weeks (range 1 to 3 weeks). The mean hospital stay was 41 days (range 31 to 46 days). The hematological profile of the patients remained normal until the last follow-up. Fusion surgery was satisfactory and all the patients showed significant improvement in complaints of back and leg pain. Bony union was achieved in a mean of 8.5 months (range 5 to 18 months). No graft failure, recurrence of infection, or significant kyphosis were noted.
Conclusion: Anterior segmental fusion using the Chuinard & Peterson bone graft followed by percutaneous facet screw fixation was found effective for pyogenic spondylitis with posterior soft tissue infection.