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

In a study the results recorded in 34 surgically treated patients with spec ific or unspecific spondylodiscitis after dorsoventral one-stage instrument ation with CDI and anterior grafting (group 1) were compared with those obt ained in a group of 38 patients treated with anterior CDH instrumentation i n combination with anterior grafting (group 2). The mean observation period s 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 operatio n. In group 1 the mean values for blood loss, operating time, length of hos pital stay and fusion length (3.5 segments)were significant higher than tho se 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 exte rnal 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 preo perative 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 i n florid spondylodiscitis a short-range anterior fusion of the affected spi nal segment can be performed with a primarystable implant, avoiding a secon d operation without an increased risk of infection-related dislocation. In the authors' own experience a secondary dorsal operation can be avoided exc ept in the case segment L-5/S-1, the fast mobilization without external sup port allows a up-to-date treatment in this severe spinal disease.