Clinical and radiographical results of minimally invasive lateral transpsoas approach for treatment of septic spondylodiscitis of thoracolumbar and lumbar spine.

Clinical and radiographical results of minimally invasive lateral transpsoas approach for treatment of septic spondylodiscitis of thoracolumbar and lumbar spine.

World Neurosurg. 2018 Apr 04;:

Authors: He L, Xie P, Shu T, Liu Z, Feng F, Chen Z, Chen R, Zhang L, Rong L

Abstract
BACKGROUND: The minimally invasive lateral transpsoas approach, allows retroperitoneal access for discectomy and graft placement. However, the procedure has rarely been used for the treatment of septic spondylodiscitis. The purposes of this study were to evaluate the clinical and radiographical outcomes from this minimally invasive procedure for septic spondylodiscitis.
METHODS: Thirty-one consecutive patients (17 males and 14 females) were included in this study from July 2013 to January 2016. Clinical outcomes were assessed by Oswestry Disability Index (ODI), visual analog scale (VAS), modified Macnab criteria and inflammatory parameters. Radiographical results were analyzed by studying the changes in diseased disc height, lordosis and fusion status.
RESULTS: The ODI and VAS score improved by 58%, and 69% at the last follow-up. The modified Macnab criteria was found to be excellent in 21 patients (68%), and good in 10 (32%). Inflammatory parameters normalized over the average 24 months' follow-up. There were no major complications that might have influenced the outcomes in this cohort. A complete fusion after 12 months was achieved in 87% of the patients. A mean 7.5 mm restoration in disc height and 6.4 degree restoration in lumbar lordosis were observed in all patients, whereas an average 4.5 mm loss in restored height resulting from graft subsidence was observed in 24 patients during the follow-up. However, graft subsidence did not influence clinical outcomes significantly.
CONCLUSIONS: Minimally invasive lateral transpsoas approach in combination with instrumentation provides a novel treatment for patients who suffer from septic spondylodiscitis without severe kyphosis and neurological impairment.

PMID: 29626684 [PubMed - as supplied by publisher]

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