Early surgical debridement and fixation for pyogenic lumbar spondylodiscitis

Abstract

Abstract Background Management of pyogenic lumbar spondylodiscitis still represent a major conflict and challenge in neurosurgery due to different pathogens and the different methods available for management. Objective The aim of this study was to evaluate the outcome of posterior lumbar spinal fixation with debridement as a treatment modality in the management of pyogenic lumbar spondylodiscitis. Patients and method This is a prospective study conducted on patients presenting to the Neurosurgery Department of Cairo University hospitals diagnosed to have either spontaneous or iatrogenic pyogenic lumbar spondylodiscitis. All cases were operated upon by surgical debridement, drainage, and posterior lumbar fixation in the same setting. Antibiotics were prescribed according to the obtained culture and sensitivity. Laboratory follow-up was done to all patients. Clinical outcome was evaluated in terms of the Denis Functional Pain Scale. Follow-up period ranged from 5 to 14 months. Results A total of 25 patients comprised of 15 males and 9 females with a mean age of 45.7 years (range 32–63 years) were included in this study. Nine cases had a previous lumbar discectomy surgery, and 15 cases presented with spontaneous spondylodiscitis. L4–5 level was the most frequent site of pyogenic discitis. Excellent outcome and good outcomes (score 1–3 in Denis Functional Pain Scale) were reported in 84% of the patients and poor outcomes (score 4–5) in 16%. Conclusion Surgical fixation and debridement can be considered as an effective modality in the management of pyogenic lumbar spondylodiscitis with early ambulation, good control of pain, and early hospital discharge.