Anterior oblique retroperitoneal approach vs posterior transpedicular approach for the treatment of one- or two-level lu
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ORIGINAL PAPER
Anterior oblique retroperitoneal approach vs posterior transpedicular approach for the treatment of one- or two-level lumbar vertebral osteomyelitis: a retrospective cohort study Wei Luo 1 & Yun-sheng Ou 1 & Xing Du 1 & Ben Wang 1 Received: 23 March 2020 / Accepted: 19 May 2020 # SICOT aisbl 2020
Abstract Objective To evaluate the outcomes of debridement fusion surgery between two surgical approaches for one- or two-level lumbar vertebral osteomyelitis (LVO): oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). Methods We performed a retrospective study for adult patients with one- or two-level lumbar vertebral pyogenic spondylitis. The primary clinical outcomes included the following: surgery-related information (intra-operative blood loss, operation time, and hospital length of stay), infection control (primary failure and recurrence), and bony fusion. The secondary objective was to determine the differences between groups in mean reduction of pain characters and physical functioning. Results The data of 80 patients were collected retrospectively. The duration of follow-up was 27.8 ± 4.7 months (range, 24–42). Intra-operative blood loss, operation time, and hospital length of stay in ORA debridement were significantly lower. Primary failure (2.3% vs 2.7%) was similar between the groups, but recurrence (13.9% vs 5.4%) had difference. Bony fusion (94.6.3% vs 86.1.%) in ORA debridement was higher than those in PTA debridement at the final follow-up. Fusion occurred at six to 14 months (mean 9.8 months). Patients in ORA group had better results in functional and pain scores in the first three months, with similar results at the final follow-up. Conclusion In summary, ORA debridement provides a quicker recovery compared with PTA debridement for one- or two-level LVO. As for the infection control and fusion rate, both debridement approaches had similar results. Keywords Lumbar vertebral osteomyelitis . Debridement . Oblique retroperitoneal approach . Posterior transpedicular approach . Pyogenic spondylitis
Introduction Many patients with lumbar vertebral osteomyelitis (LVO) can be treated with appropriate antibiotic therapy only. Surgical intervention is needed in the settings of neurological complications and rapid progress condition [1]. The anterior approach debridement that seems to be more reasonable for LVO patients mainly involves vertebral bodies and disc. Anterior approach provides direct access to the infected focus. As for the pathology located in the posterior and/or both psoas
* Yun-sheng Ou [email protected] 1
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing 400016, People’s Republic of China
muscle involvement, the posterior decompression has its advantages. Posterior approach provides indirect access to the infected focus. However, the choice of debridement approach selection in LVO continues to be a debate [2, 3], and recent reviews preferred a
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