Revision Surgery for Postoperative Spondylodiscitis at Cage Level after Posterior Instrumented Fusion in the Lumbar Spine—Anterior Approach Is Not Absolutely Indicated

Abstract

Spondylodiscitis at the cage level is rare but remains a challenge for spine surgeons. In this study, the safety and efficacy of revision surgery by a posterior approach to spondylodiscitis developed at the cage level were evaluated, and these data were compared to those of patients treated with revision surgeries using the traditional anterior plus posterior approach for their infections. Twenty-eight patients with postoperative spondylodiscitis underwent revision surgeries to salvage their infections, including 15 patients in the study group (posterior only) and 13 patients in the control group (combined anterior and posterior). Staphylococcus aureus was the most common pathogen in both groups. L4-L5 was the most common infection site in both groups. The operation time (229.5 vs. 449.5 min, p < 0.001) and blood loss (427.7 vs. 1106.9 mL, p < 0.001) were the only two data points that were statistically significantly different between the two groups. In conclusion, a single posterior approach with ipsilateral or contralateral transforaminal lumbar interbody debridement and fusion plus extending instrumentation was safe and effective for spondylodiscitis developed at the cage level. This strategy can decrease the operation time and blood loss.