Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis

Neal B. Patel, Zachary H. Dodd, Jason Voorhies, Eric Horn

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more extensive treatment.

Original languageEnglish (US)
Pages (from-to)1753-1757
Number of pages5
JournalJournal of Clinical Neuroscience
Volume22
Issue number11
DOIs
StatePublished - Nov 1 2015

    Fingerprint

Keywords

  • Discitis
  • Neurosurgical procedures
  • Osteomyelitis
  • Surgical approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

Cite this