Extreme Lateral Interbody Fusion as a Feasible Treatment for Thoracolumbar Spondylodiscitis: A Multicenter Belgian Case-Series

Abstract

BACKGROUND: Spondylodiscitis is, after tissue sam-pling, initially managed with intravenous antibiotics. In patients with treatment failure, surgical debridement and stabilization is considered. An anterior or posterior approach has already been reported as a successful sur-gical access, but is associated with a large exposure and a significant morbidity.METHODS: We present a multicenter Belgian case -series on the use of a minimally invasive extreme lateral interbody fusion procedure with add-on percutaneous pedicle screw fixation for patients with a need for surgical debridement and tissue samples or intractable back pain due to spondylodiscitis. Patient characteristics, microbi-ology results, antibiotic treatment, pre-and postoperative Visual Analogue Pain Score (VAS) scores, time to bony consolidation, complications and duration of the hospital stay were collected.RESULTS: Seven patients with one level spondylodisci-tis were included. The mean age 64 years with a mean preoperative VAS score of 8.86 ( +/- 0.90). Postoperative VAS score significantly decreased to 2.57 (L70.3%, P < 0.001). Mean antibiotic treatment duration was 8 weeks. Median duration of the hospital stay was 14 days. Patients were followed for 1 year. Complete bony consolidation was observed in 6 out of 7 patients after 1 year. One patient had a stable pseudarthrosis.CONCLUSIONS: These results indicate that extreme lateral interbody fusion topped off with a percutaneous pedicle screw fixation might be a feasible, safe and valuable choice to surgically treat patients with spondy-lodiscitis with fast and important improvement in VAS. Further prospective research might strengthen the sparsely existing literature of minimally invasive surgery for spon-dylodiscitis to provide the best possible care.