Operative treatment of spondylodiscitis--what is the most effective approach?

In a study the results recorded in 34 surgically treated patients with specific or unspecific spondylodiscitis after dorsoventral one-stage instrumentation with CDI and anterior grafting (group 1) were compared with those obtained in a group of 38 patients treated with anterior CDH instrumentation in combination with anterior grafting (group 2). The mean observation periods were 48.4 (19-82) months in group 1 and 29.0 (8-54) months in group 2. In both groups the infection healed after fusion without a secondary operation. In group 1 the mean values for blood loss, operating time, length of hospital stay and fusion length (3.5 segments) were significant higher than those in group 2; in particular, the fusion length was shorter (1.3 segments) in group 2. Only 8 patients in group 1 were treated with postoperative external support. The mean preoperative segmental angle of 18.2 degrees (group 1) was corrected by a mean of 11.9 degrees, and the reposition loss during follow-up amounted to an average of 2.7 degrees. Group 2 showed a mean preoperative segmental deformity angle of 13.4 degrees, which was corrected by 11.6 degrees, and the loss of reposition was 2.9 degrees on average. Even in florid spondylodiscitis a short-range anterior fusion of the affected spinal segment can be performed with a primary stable implant, avoiding a second operation without an increased risk of infection-related dislocation. In the authors' own experience a secondary dorsal operation can be avoided except in the case segment L-5/S-1, the fast mobilization without external support allows a up-to-date treatment in this severe spinal disease.