The role of discectomy in reducing infectious complications after surgery for lumbar spondylodiscitis.

Introduction Surgery for pyogenic spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate discectomy in all cases. Others maintain that standalone instrumentation is sufficient. Patients and methods We reviewed charts of patients who underwent instrumentation for pyogenic spondylodiscitis with a minimum follow-up of one year. Patients were stratified according to whether they underwent discectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision and construct failure. Results N=257 patients who underwent surgery for pyogenic spondylodiscitis were identified. Discectomy and interbody procedure (group A) was performed in 102 patients while 155 patients underwent instrumentation surgery for spondylodiscitis without intradiscal debridement (group B). Mean age was 67±12 years, 102 patients (39.7%) were female. No significant differences were found in the need for epidural abscess recurrence therapy (group A (2.0%) and 5 cases in group B (3%; p=0.83)) and construct failure (p=0.575). The need for wound revisions showed a tendency towards higher rates in the posterior instrumentation only group which failed to reach significance (p=0.078). Conclusions Overall, intraspinal relapse of surgically treated pyogenic discitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no discectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population.