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Journal of Korean Neurosurgical Society > Volume 43(1); 2008 > Article
Journal of Korean Neurosurgical Society 2008;43(1): 5-10.
doi: https://doi.org/10.3340/jkns.2008.43.1.5
Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis.
Jae Kwan Lim, Sung Min Kim, Dae Jean Jo, Tae One Lee
1Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea.
2Department of Neurosurgery, East-West Neo Medical Center, Kyunghee University, Seoul, Korea. spinekim@khu.ac.kr
To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis in patients who had failed medical management.
A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed.
There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from 3.78+/-0.78 preoperatively to 4.78+/-0.35 at final follow up and mean VAS score was improved from 7.43+/-0.54 to 2.07+/-1.12. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations.
According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.
Key Words: Advanced spondylodiscitis; Ventral interbody grafting; Spinal instrumentation
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