Spondylodiscitis instrumented fusion, a prospective case series on a standardized neurosurgical protocol with long term follow up

Abstract

Purpose: To investigate the fusion construct properties, construct length, intervertebral prosthesis (IVP) selection, bone grafting methods, complications management, and follow-up outcomes of spondylodiscitis fusion. Method: This case series was conducted in Al-Zahra University referral hospital from March 2016 to November 2021. All the surgery-eligible patients were enrolled. Those who did not participate or failed the neurosurgical intervention were excluded. A unified neurosurgical protocol was defined. After operation and follow-up, all variables were documented. IBM SPSS v.26 was used for data analysis. P-value <= 0.05 was considered significant. Result: Ninety-two patients were reviewed in the final analysis with 65.2 males. The mean age was 55.07 +/- 14.22 years old. The most frequent level of pathology and surgery was the lumbar spine (48.9 ). Short and long constructs were almost equally used (57.6 and 42.4 , respectively). Bone graft mixture was the dominant IVP (75 ). The most frequent persistent postoperative symptom was back pain (55.4 ), while the neurological deficits resolution rate was 76.7 . The fusion rate was 92.3 . Proximal junctional kyphosis incidence was 16.3 and had a significant association with on-admission neurological symptoms, thoracic and thoracolumbar junction involvements (p < 0.05). Follow-up Oswestry disability index scores showed 44.6 of the patients had mild or no functional disabilities. Advanced age, On-admission deficits, comorbidities, titanium cages, and poor fusion status were associated with poor functional outcomes and higher mortality rates (P < 0.05). Conclusion: The introduced neurosurgical protocol could effectively achieve acceptable SD treatment, spine stabilization, and fusion with low long-term surgical complications. Autologous bone graft mixture in comparison to titanium cages showed a higher fusion rate with a lower mortality rate. Patients with older age, neurological symptoms, and comorbidities are expected to experience less favorable clinical outcomes.