Operative Treatment of Lumbosacral Spondylitis Through a Posterior-only Approach / 대한정형외과학회잡지

ABSTRACT

PURPOSE: To evaluate the efficacy of this operative method, which includes removal of infected materials, insertion of a bone graft and fixation with pedicle screws through a posterior-only approach in spondylitis with advanced bone destruction and radicular pain. MATERIALS AND METHODS: Ten patients with refractory single level spondylitis of the lumbosacral spine, who underwent the above operation and were followed-up for more than 2 years, were analyzed retrospectively. Six cases were tuberculous and 4 cases were pyogenic in etiology. Radiologically, bone union and restoration of sagittal alignment were assessed. Clinically, Visual Analog Scales (VAS) for back pain, leg pain and resolution of neurologic symptom were analyzed. RESULTS: Bone union was achieved in all cases. Sagittal angle was corrected significantly from -3.6+/-12.5 degrees to -11.4+/-9.3 degrees (p=0.007). However, loss of correction was noted from -16.2+/-10.2 degrees at immediate after surgery to -11.4+/-9.3 degrees at last follow-up (p=0.005). Back pain VAS was improved from 8.3+/-0.7 to 2.6+/-1.6 (p=0.005) and leg pain VAS was improved from 6.8+/-2.1 to 0.5+/-0.9 (p=0.005). There was strong positive correlation between age and final back pain (r=0.79, p=0.011) and leg pain VAS (r=0.75, p=0.020). There was no meaningful correlation between the sagittal angle and back pain (r=0.30, p=0.430) and leg pain VAS (r=0.41, p= 0.274). Implant related complications and deep wound infections did not occur. CONCLUSION: In single level spondylitis of the lumbosacral spine, a posterior-only surgical approach is a useful method in which debridement, bone graft placement and pedicle screw fixation can be performed. This procedure did not provide increased risk with respect to infection control, and it allowed correction of the sagittal angle. The younger the age of the patients, the better the back pain and leg pain VAS results.