Minimally Invasive Transforaminal Lumbar Interbody Debridement and Fusion with Percutaneous Pedicle Screw Instrumentation for Spondylodiscitis

BACKGROUND: Minimally invasive transforaminal lumbar interbody debridement and fusion (MiTLIDF) with percutaneous pedicle screw instrumentation (PSI) is a less invasive treatment for lumbar spondylodiscitis. METHODS: Patients with single-level lumbar spondylodiscitis were surgically treated by interbody debridement and fusion through an anterior or transforaminal approach combined with open or percutaneous PSI (group A: anterior debridement and interbody fusion with open posterior PSI; group B: transforaminal lumbar interbody debridement and fusion [TLIDF] with open posterior PSI; group C: anterior debridement and interbody fusion with percutaneous PSI; group D: MiTLIDF with percutaneous PSI). Perioperative data, fusion status, infection-free survival, and clinical outcome measurements were compared among the 4 surgical groups. RESULTS: A total of 82 patients were included in this study. TLIDF was associated with shorter operative time when compared with the anterior approach (group A: 302.8 +/- 59.9 minutes; group B: 209.2 +/- 31.0 minutes; group C: 260.6 +/- 62.5 minutes; group D: 207.1 +/- 33.6 minutes; P < 0.001). Percutaneous PSI resulted in less intraoperative blood loss (group A: 907.5 +/- 253.7 mL; group B: 859.4 +/- 201.2 mL; group C: 532.9 +/- 193.7 mL; group D: 399.1 +/- 84.3 mL) and reduced immediate postoperative pain (group A: 5.5 +/- 0.9; group B: 4.9 +/- 0.9; group C: 3.9 +/- 0.7; group D: 3.2 +/- 0.7) than open PSI (P< 0.001). There were no significant differences in terms of overall infection-free survival (P = 0.936). CONCLUSIONS: This study demonstrated MiTLIDF with percutaneous PSI is a safe and effective treatment for lumbar spondylodiscitis while incurring no adverse effects in terms of fusion rate, functional recovery, and infection eradication.