Chia-Wei Chang1, Tsai-Sheng Fu1, Wen-Jer Chen2, Chien-Wen Chen2, Po-Liang Lai2, Shih-Hao Chen3. 1. Department of Orthopaedic Surgery, Keelung Branch of Chang Gung Memorial Hospital, Keelung, Taiwan. 2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linko, Taiwan. 3. Department of Orthopaedic surgery, Taichung Branch of Buddhist Tzu-Chi General Hospital, Taichung City, Taiwan. Electronic address: shihhaotzuchi@gmail.com.
Abstract
BACKGROUND: The postoperative infection rates for transforaminal lumbar interbody fusion (TLIF) have ranged from <2% to 4%. However, no consensus has been reached on the treatment strategies. TLIF cage preservation or revision surgery for lumbar spine reconstruction are 2 possible treatments. We aimed to determine the most effective method for organ/space infection control. METHODS: The data from 4923 patients who had undergone TLIF with cage and posterior pedicle-screw instrumentation for spondylolysis or degenerative spondylolisthesis from January 2008 to December 2015 were retrospectively analyzed. Of the 4923 patients, 32 (0.65%) had developed organ/space infection of the interbody cage and were divided into 2 groups: those whose interbody cage was removed for revision (group 1) and those who interbody cage was retained (group 2). We compared the initial management of both groups in terms of age, sex, elapsed time to diagnosis, changes in spinal lordotic angle, visual analog scale score, fusion status, and Kirkaldy-Willis functional outcomes. RESULTS: The 32 patients with organ/space infection had a mean age of 66.3 years and a follow-up period of 23.8 months. Significant differences were observed in the mean elapsed time to diagnosis (P = 0.004), lordotic angle correction at the disease level (P = 0.03), and Kirkaldy-Wallis functional outcomes (P = 0.01). Of the 17 patients undergoing debridement for implant retention, 9 (52.9%) exhibited poor results. CONCLUSIONS: The most important factor contributing to TLIF cage retention failure was epidural fibrosis of the previous transforaminal route and biofilm adhesion on interbody devices affecting infection clearance. Thus, we would recommend a combined anterior and posterior approach or the transforaminal route for radical debridement with cage removal and fusion to achieve better clinical outcomes.
BACKGROUND: The postoperative infection rates for transforaminal lumbar interbody fusion (TLIF) have ranged from <2% to 4%. However, no consensus has been reached on the treatment strategies. TLIF cage preservation or revision surgery for lumbar spine reconstruction are 2 possible treatments. We aimed to determine the most effective method for organ/space infection control. METHODS: The data from 4923 patients who had undergone TLIF with cage and posterior pedicle-screw instrumentation for spondylolysis or degenerative spondylolisthesis from January 2008 to December 2015 were retrospectively analyzed. Of the 4923 patients, 32 (0.65%) had developed organ/space infection of the interbody cage and were divided into 2 groups: those whose interbody cage was removed for revision (group 1) and those who interbody cage was retained (group 2). We compared the initial management of both groups in terms of age, sex, elapsed time to diagnosis, changes in spinal lordotic angle, visual analog scale score, fusion status, and Kirkaldy-Willis functional outcomes. RESULTS: The 32 patients with organ/space infection had a mean age of 66.3 years and a follow-up period of 23.8 months. Significant differences were observed in the mean elapsed time to diagnosis (P = 0.004), lordotic angle correction at the disease level (P = 0.03), and Kirkaldy-Wallis functional outcomes (P = 0.01). Of the 17 patients undergoing debridement for implant retention, 9 (52.9%) exhibited poor results. CONCLUSIONS: The most important factor contributing to TLIF cage retention failure was epidural fibrosis of the previous transforaminal route and biofilm adhesion on interbody devices affecting infection clearance. Thus, we would recommend a combined anterior and posterior approach or the transforaminal route for radical debridement with cage removal and fusion to achieve better clinical outcomes.
Authors: Matthew T Neal; Kara L Curley; Alexandra E Richards; Maziyar A Kalani; Mark K Lyons; Victor J Davila Journal: J Neurosurg Case Lessons Date: 2021-01-25