Anterior Debridement and Fusion Followed by 360° Fixation in Pyogenic Spontaneous Spondylodiscitis of L4- L5: Autologous Iliac Bone Strut, Anterior Titanium Screw- Rod Fixation and Posterior Pedicle Screw Fixation: A Case Report

Objective: To describe a new kind of 360° fixation in pyogenic spontaneous spondylodiscitis of L4L5 after anterior debridement and fusion. Summary of Background Data: The adequate surgical treatment modalities for pyogenic spontaneous spondylodiscitis has not been unequivocally defined until present, especially in the use of metal instruments at such a septic focus. Methods: The 54-year patient, who was in an active period of pyogenic spondylitis, treated with surgical intervention involved aggressive anterior debridement and removal of the infected vertebral body of L4 -L5, followed by reconstruction of the anterior column using autologous iliac bone strut and anterior titanium screw-rod fixation (in L4 and L5 residual vertebral body), and posterior pedicle screw fixation in L3 and S1. The patient was given antibiotic treatment with cefotiam, initially with intravenous administration, which was switched to oral administration after 21 days. Results: No further relapse of spondylodiscitis have been detected during routine clinical and radiographic check-ups, with ongoing follow-up. The inflammatory parameters have been in the normal range. The patient is well mobilized, using walking feet for long distances, and she has no obvious pain. The radiographs showed the disappearance of extramedullary abscess, no changes in the implant such as loosening of the screws or fracture, iliac bone graft absorption collapse, and partial fusion between vertebral body and bone graft. Conclusion: This new 360° fixation may be a good surgical treatment alternative, especially in an active period of pyogenic spondylitis, with significant and irregular bone defects.