Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable?

TY - JOUR

T1 - Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable?

AU - Dreimann, Marc

AU - Ryang, Yu-Mi

AU - Schoof, Benjamin

AU - Thiesen, Darius Maximilian

AU - Eicker, Sven Oliver

AU - Strube, Patrick

AU - Stangenberg, Martin

PY - 2020/11/18

Y1 - 2020/11/18

N2 - Introduction Very few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/ TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspec- tives from a spine surgeon’s point of view in this seriously affected patient group. Materials and methods A retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylo- discitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis. Results All 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied. Conclusions Destructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.

AB - Introduction Very few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/ TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspec- tives from a spine surgeon’s point of view in this seriously affected patient group. Materials and methods A retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylo- discitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis. Results All 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied. Conclusions Destructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.

U2 - 10.1007/s00402-020-03672-4

DO - 10.1007/s00402-020-03672-4

M3 - SCORING: Journal article

C2 - 33206206

VL - 2020

JO - ARCH ORTHOP TRAUM SU

JF - ARCH ORTHOP TRAUM SU

SN - 0936-8051

ER -