• Anja Tschugg, Sebastian Hartmann, Sara Lener, Andreas Rietzler, Neururer Sabrina, and Claudius Thomé.
• Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. anja.tschugg@i-med.ac.at.
• Eur Spine J. 2017 Dec 1; 26 (12): 3141-3146.

BackgroundMinimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed.Methods67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome.ResultsPreoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018).ConclusionThe open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

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