Percutaneous pedicle screw fixation in the surgical treatment of monosegmental pyogenic spondylodiscitis.

Abstract

Objective: The study assessed the efficacy of percutaneous pedicle screw fixation (PPSF) as a treatment approach for monosegmental pyogenic spondylodiscitis (PS), particularly in patients with compromised health conditions that reduce their ability to endure extensive surgical procedures.

Methods: From January 2019 and December 2021, a total of 38 patients with PS who underwent PPSF at our hospital were included in the study. Clinical outcomes were assessed using physical examinations, serological tests, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and imaging assessments.

Results: The mean duration of PPSF among all patients was 73.9 ± 13.9 min, with an average intraoperative blood loss of 52.4 ± 18.4 mL. Pathogenic bacteria were identified in 17 out of 38 cases, representing a detection rate of 44.7%. The mean follow-up period was 21.3 ± 8.3 months. Postoperative assessment of inflammatory markers indicated that infections were effectively controlled in 33 patients, resulting in symptomatic improvement. However, within 2 to 4 weeks postoperatively, 5 patients required a two-stage anterior debridement-fusion following the initial internal fixation. Compared to those who underwent posterior internal fixation alone, these patients had significantly higher Spinal Instability Spondylodiscitis Scores (12.000 ± 1.000 vs. 9.030 ± 2.114, p < 0.05) and a significantly greater prevalence of preoperative epidural abscesses (80% vs. 12.1%, p < 0.01).

Conclusions: PPSF may serve as a viable option for patients with monosegmental PS, providing a minimally invasive surgical approach for patients who are unable to tolerate traditional open surgery due to compromised health or advanced age. For patients with significant spinal instability or abscess formation, a two-stage anterior debridement-fusion may be required. However, single-stage posterior internal fixation can effectively relieve pain and improve the overall condition of patients, thereby enhancing their ability to tolerate subsequent anterior surgical interventions.