Anterior versus Posterior Approach in Surgical Treatment of Dorsolumber Spondylodiscitis

Abstract

Background: Spinal infections exhibit a wide range of clinical signs. The clinical effects can encompass the vertebral bodies, spinal canal, intervertebral discs, and adjacent paravertebral structures. Surgical treatment becomes necessary when there's a presence of neurological deficits, epidural abscess, or the development of kyphotic deformity. The approach involving anterior debridement and fusion has demonstrated its efficacy in managing pyogenic spondylodiscitis. This method facilitates direct reach to the infected disc, allowing thorough debridement and proper placement of bone graft to ensure adequate stabilization. On the other hand, the posterior approach is more proficient in correcting kyphosis. Aim: The aim of this thesis is to conduct a comprehensive comparison of the clinical, radiological, and functional outcomes between the surgical approaches of anterior and posterior methods in the treatment of spondylodiscitis. Patients and methods: A prospective cohort study was conducted in Benha university hospital including thirty patients with dorsolumber spondylodiscitis were admitted and managed operatively between May 2020 and June 2023. Patients were divided into two groups. Group (A): 15 patients (50%) were operated via anterior approach and group (B): 15 patients (50%) were operated via posterior approach. The diagnosis was confirmed through a combination of clinical presentation, laboratory analyses, and radiological evaluations. The study involved a 12-week follow-up period to assess the progression and outcomes of the condition. Results: The mean age of patients of group A was 52 ±8 and group B was 52 ±7. The most frequent site in group A was lumbar (46.7%), followed by thoracolumbar (40%) and thoracic (13.3%), while in group B, the most frequent was lumbar (40%), followed by thoracic (33.35) and thoracolumbar (26.7%). Functional outcome (regarding Oswestry disability index) was improved from 84% and 82% preoperatively to 28% and 30% postoperatively in Group A and Group B respectively. Regarding Local Kyphotic Angle, group B demonstrated significantly higher correction degrees than the anterior approach group A. Regarding hospital stay in our study, Group B demonstrated significantly higher hospital stay than group A. Also, Posterior group exhibited significantly higher operative time and blood loss. Conclusion: Both the anterior and posterior approaches are effective in accomplishing the objectives of surgical intervention for thoracic and lumbar Spondylodiscitis. However, the posterior approach provides notably superior correction of the kyphotic angle, albeit at the cost of increased operative time, prolonged hospital stay, and greater blood loss.