Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): ra
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ORTHOPAEDIC SURGERY
Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable? Marc Dreimann1 · Yu‑Mi Ryang2 · Benjamin Schoof1 · Darius Thiessen1 · Sven Oliver Eicker3 · Patrick Strube4 · Martin Stangenberg1 Received: 27 April 2020 / Accepted: 27 October 2020 © The Author(s) 2020
Abstract 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 perspectives 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 spondylodiscitis 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. Keywords EVAR · TEVAR · Per continuitatem spondylodiscitis · Spinal osteomyelitis
Introduction
Marc Dreimann and Yu-Mi Ryang contributed equally to this study and, therefore, share first authorship. * Marc Dreimann [email protected] 1
Department of Trauma and Orthopedic Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
2
Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany
3
Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
4
Department of Orthopaedic Surgery, Universitätsklinikum Jena, Campus Waldkliniken Eisenberg, Eisenberg, Germany
In recent years, a modern minimally invasive procedure for aortic aneurysm treatment has been introduced, called endovascular aortic repair (EVAR). Since it was first described in 1991 [1], EVAR has become the preferred method over open surgical repair for the treatment of abdominal aortic aneurysms in patients with suitable anatomy due to its lower mortality rate and comparable long-term survival [2, 3]. Aortic graft infectio
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