Dorsolateraler zugang und interkorporelle spondylodese bei spondylodiszitis der brust- und lendenwirbelsäule (TLIF-technik)

UNLABELLED: SURGICAL GOAL: Resolve infection and achieve primary stability of instrumentation and permanent fusion of the affected spinal segment by means of debridement of the focus of infection. Defect-filling using autologous/allograft bone or a spacer, as well as immobilization by means of dorsal instrumentation.

INDICATION: Acute and chronic thoracolumbar spondylodiscitis.

CONTRAINDICATIONS: Purely epidural abscesses requiring only decompression (fenestration). Defects whose size make a ventral approach necessary.

SURGICAL TECHNIQUE: Classic dorsal approach to the thoracolumbar spine. Pedicle placed using screws depending on the size of the spinal defect for mono-, bi-, or multisegmental spinal fusion. Exposure performed at the level of the infected spinal disc or vertebral body on the more strongly affected side. Focus of infection removed. Depending on the degree of infection, defect filling is carried out using autologous bone or cancellous allograft, followed by rod assembly.

POSTOPERATIVE MANAGEMENT: Back brace-free follow-up treatment, physiotherapy and back training. Antibiotic administration until inflammation values fall within the normal range, or for at least 14 days.

RESULTS: Successful fusion of affected segments, including resolution of infection, is reported in over 90% of cases described in the literature. The revision rate among our mostly multimorbid patient group with an average age of 66 years was 16%. Of 39 of the 114 (34%) patients with preoperative neurological deficits, 26 (66%) demonstrated postoperative regression. Nine patients (23%) showed no improvement, whilst exacerbation of existing neurological deficits was seen in four patients (11%). Staphylococcus was the major pathogen in 34% of cases.