Surgical Management of Post-Discectomy Spondylodiscitis with Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Instrumentation

Background: Post operative lumbar disc space infection is relatively uncommon. The anterior approach has been the traditional surgical approach for treatment of this complication. Posterior approach was sometimes added for instrumentation only. Purpose: To present the results and clinical outcome, at a minimum of twelve months, following transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation for post-discectomy spondylodiscitis. Study design: A case series Materials and Methods: Nine patients (age 38– 68 years; mean: 47.8 years) with post-lumbar discectomy spondylodiscitis, were treated surgically by TLIF and posterior spinal instrumentation. All patients had significant back pain despite a full conservative treatment regimen by broad spectrum antibiotics and brace. The follow-up ranged from 12 to 36 months with an average of 22 months. All patients were available for follow up which included physical examination, scoring of function and radiographs. Outcome measures: To assess the invasiveness of the operation, we evaluated operative time, blood loss, and complications. Visual pain analogue scale (VPAS), activities of daily living (ADL) (Barthel index), CRP, and ESR in the preoperative, postoperative and final follow-up periods were used to evaluate the surgical outcome. Results: Although we encountered some postoperative complications including wound infection; at the final follow-up visit, VPAS and Barthel index improved in all patients. Changes in CRP and ESR revealed suppression of infection in all cases. Conclusion: Surgical treatment for postoperative spondylodiscitis with TLIF and posterior spinal instrumentation provides patients with satisfactory final outcomes. [Ahmed Fathey Sheha Surgical Management of Post-Discectomy Spondylodiscitis with Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Instrumentation.] Life Science Journal,. 2011; 8(4): 296-303] (ISSN: 1097-8135). http://www.lifesciencesite.com. Key-words: Pyogenic spondylodiscitisTransforaminal Lumbar Interbody Fusion (TLIF) Posterior Spinal instrumentation.