One-stage surgical management for cervical pyogenic spondylodiscitis by anterior debridement, reconstruction, and instrumentation: a single-center experience.

Abstract

Study design: Retrospective cohort study.

Objectives: Surgical treatment is an effective strategy for cervical pyogenic spondylodiscitis (CPS). However, the optimal surgical approach is uncertain. This study was conducted to evaluate the clinical efficacy of debridement, reconstruction, and instrumentation via the anterior-only approach for CPS.

Methods: We retrospectively collected the data of patients with CPS who underwent one-stage anterior debridement, reconstruction, and instrumentation from January 2013 to December 2022. The surgical duration and blood loss volume were analyzed. The Frankel grading classification was used to evaluate the improvement in neurological function. The Visual Analog Scale (VAS) and Japanese Orthopedic Association (JOA) scores were used to evaluate neck pain and functional recovery. The radiological parameters of regional lordosis angle (RLA) and C2-C7 Cobb angle were used to evaluate the recovery of cervical alignment. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated to assess the control of infection.

Results: Totally, 32 patients were eligible. The surgical duration was 118.9 ± 14.3 minutes, and the blood loss volume was 88.4 ± 42.7 mL. Significant improvements in the Frankel grading were observed in patients with neurological deficit. The VAS and JOA scores significantly improved postoperatively and during follow-up (P < 0.01). The RLA significantly increased from 4.0° ± 6.6° preoperatively to 8.4° ± 5.8° at the final follow-up (P < 0.01). The C2-C7 Cobb angle increased from 11.1° ± 7.1° preoperatively to 13.8° ± 7.2° at the final follow-up (P < 0.01). Bony fusion occurred in all patients. CRP and ESR significantly decreased postoperatively and returned to normal during follow-up.

Conclusions: One-stage debridement, reconstruction, and instrumentation via the anterior approach is an effective surgical strategy for CPS. In addition to surgery, targeted and prolonged antibiotic therapy is of crucial importance.