Percutaneous Posterior Instrumentation Followed by Direct Lateral Interbody Fusion for Lumbar Infectious Spondylitis

Study Design: Retrospective study. Objectives: To investigate the clinical feasibility and outcomes from direct lateral interbody fusion (DLIF) using autogenous bone grafts and percutaneous posterior instrumentation (PPI) for infectious spondylitis. Summary of Background Data: As one of the minimally invasive techniques, PPI has been attempted for various degenerative lumbar spine disorders combined with anterior lumbar interbody fusion or transforaminal lumbar interbody fusion. PPI has been played more roles recently as an internal fixation method for infectious spondylitis. However, the clinical outcomes of DLIF using an autogenous bone graft combined with PPI for infectious spondylitis have been rarely reported. Materials and Methods: Sixteen patients (mean age, 60.3 +/- 18.8 y) who suffered from pyogenic spondylitis underwent single-stage DLIF using an autogenous iliac bone graft combined with PPI. Clinical and radiologic outcomes were evaluated by visual analog scale (VAS), Oswestry Disability Index (ODI), and eradication of primary disease. Radiologic outcomes were evaluated by changes of affected segmental lordosis and fusion status. Results: Bony fusion and eradication of primary disease were obtained in all patient except 1 case during the follow-up (mean, 31.3 +/- 13.1 mo; range 14-46 mo). Preoperative VAS (7 +/- 1.2) and ODI (61.3 +/- 5.4) scores improved significantly at the last follow-up (VAS, 3.4 +/- 1.5; ODI, 32.3 +/- 15.4). C-reactive protein normalized at postoperative 20.1 +/- 0.7 days (range, 15-28 d). Although height and lordosis in the affected segment were restored by surgery, all patients showed loss of the restored lordosis and height at the final follow-up. Loss of the restored lordosis and height were related to subsidence of the grafted bone. Conclusions: Minimally invasive PPI followed by debridement and DLIF was a feasible surgical alternative in our consecutive 16 cases of pyogenic spondylitis. In most cases, however the subsidence of anteriorly grafted fusion was inevitable despite successful fusion and eradication of the primary lesion.