TITLE:
Evaluation of Percutaneous Pedicle Screw Fixation in Patients with Pyogenic Spondylitis of the Thoracolumbar Spine
AUTHORS:
Katsunori Fukutake, Akihito Wada, Daisuke Kamakura, Kazumasa Nakamura, Shintaro Tsuge, Keiji Hasegawa, Hiroshi Takahashi
KEYWORDS:
Pyogenic Spondylitis, Percutaneous Pedicle Screw Fixation
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.10 No.11,
November
23,
2020
ABSTRACT: Background: Basic principle for the treatment
of pyogenic spondylitis (PS) is conservative care, but surgical intervention is
often required when conservative treatment may fail. We have experienced many conservative
cases of various complications due to long-term bed rest and poor pain control.
Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment
of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity
of the conservative care. Objective: To evaluate the impact of PPS
fixation in patients with PS. Study Design: A retrospective analysis of the
medical records. Subjects, Methods: We reviewed 54 consecutive patients
who underwent treatment in our hospital for PS during 2005-2018 and observed for
more than 12 months. Of those we excluded cases showing effectiveness to initial treatment (it was defined fever relief or C-reactive
protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective
study in cases showing initial treatment resistance.
Finally, this study included 29 cases. Medical records of these 29 cases were reviewed
for baseline, organism isolated and its detection rate, the clinical outcome in
12 months (Discharge, Transfer, Death), the period from the first visit to our hospital to fever relief, CRP inversion, ambulation, and
Discharge or Transfer. Results: These cases were divided into two groups, the conservative group (C-group): 17 cases, and the
PPS group (P-group): 12 cases. There is no statistically significant difference
in fever relief (p = 0.051) and CRP inversion (p = 0.208). The period to ambulation and discharge or transfer was significantly
shorter in group P (p = 0.020, p = 0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group.
There is no statistically significant difference (p = 0.354) between the two groups. The rate of
Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the
rate of Transfer is 34% in P-group, and 35% in C-group. Conclusion: PPS fixation was effective to achieve shortening the period to ambulation and discharge or transfer. But it was not effective in infection control. This suggests that PPS fixation should be aggressively
administered to patients who can expect pain relief and early ambulation by PPS
fixation in the patient of PS showing resistance to initial treatment.