PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases
Background: Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is...
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MDPI AG
2022-02-01
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| Series: | Bioengineering |
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| Online Access: | https://www.mdpi.com/2306-5354/9/2/73 |
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| author | Moritz Caspar Deml Emmanuelle N. Cattaneo Sebastian Frederick Bigdon Hans-Jörg Sebald Sven Hoppe Paul Heini Lorin Michael Benneker Christoph Emanuel Albers |
| author_facet | Moritz Caspar Deml Emmanuelle N. Cattaneo Sebastian Frederick Bigdon Hans-Jörg Sebald Sven Hoppe Paul Heini Lorin Michael Benneker Christoph Emanuel Albers |
| author_sort | Moritz Caspar Deml |
| collection | DOAJ |
| description | Background: Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is often impossible. Therefore, we developed the “Cement-PLIF”, a single-stage posterior lumbar procedure, combining posterior lumbar interbody fusion (PLIF) with defect-filling using antibiotic-loaded polymethylmethacrylate (PMMA). This study first describes and evaluates the procedure’s efficacy, safety, and infection eradication rate. Radiological implant stability, bone-regeneration, sagittal profile reconstruction, procedure-related complications, and pre-existing comorbidities were further analyzed. Methods: A retrospective cohort study analyzing 73 consecutive patients with a minimum of a one-year follow-up from 2000–2017. Patient-reported pain levels and improvement in infectious serological parameters evaluated the clinical outcome. Sagittal profile reconstruction, anterior bone-regeneration, and posterior fusion were analyzed in a.p. and lateral radiographs. A Kaplan–Meier analysis was used to determine the impact of pre-existing comorbidities on mortality. Pre-existing comorbidities were quantified using the Charlson-Comorbidity Index (CCI). Results: Mean follow-up was 3.3 (range: 1–16; ±3.2) years. There was no evidence of infection persistence in all patients at the one-year follow-up. One patient underwent revision surgery for early local infection recurrence (1.4%). Five (6.9%) patients required an early secondary intervention at the same level due to minor complications. Radiological follow-up revealed implant stability in 70/73 (95.9%) cases. Successful sagittal reconstruction was demonstrated in all patients (<i>p</i> < 0.001). There was a significant correlation between Kaplan–Meier survival and the number of pre-existing comorbidities (24-months-survival: CCI ≤ 3: 100%; CCI ≥ 3: 84.6%; <i>p</i> = 0.005). Conclusions: The Cement-PLIF procedure for pyogenic erosive spondylodiscitis is an effective and safe treatment as evaluated by infection elimination, clinical outcome, restoration, and maintenance of stability and sagittal alignment. |
| first_indexed | 2024-03-09T22:35:24Z |
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| institution | Directory Open Access Journal |
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| spelling | doaj.art-06f0edb513934011992394f484d02eec2023-11-23T18:48:41ZengMDPI AGBioengineering2306-53542022-02-01927310.3390/bioengineering9020073PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 CasesMoritz Caspar Deml0Emmanuelle N. Cattaneo1Sebastian Frederick Bigdon2Hans-Jörg Sebald3Sven Hoppe4Paul Heini5Lorin Michael Benneker6Christoph Emanuel Albers7Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic and Spine Surgery, Spital Thun, 3600 Thun, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic and Spine Surgery, Sonnenhof Spital, University Bern, 3006 Bern, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, 3010 Bern, SwitzerlandBackground: Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is often impossible. Therefore, we developed the “Cement-PLIF”, a single-stage posterior lumbar procedure, combining posterior lumbar interbody fusion (PLIF) with defect-filling using antibiotic-loaded polymethylmethacrylate (PMMA). This study first describes and evaluates the procedure’s efficacy, safety, and infection eradication rate. Radiological implant stability, bone-regeneration, sagittal profile reconstruction, procedure-related complications, and pre-existing comorbidities were further analyzed. Methods: A retrospective cohort study analyzing 73 consecutive patients with a minimum of a one-year follow-up from 2000–2017. Patient-reported pain levels and improvement in infectious serological parameters evaluated the clinical outcome. Sagittal profile reconstruction, anterior bone-regeneration, and posterior fusion were analyzed in a.p. and lateral radiographs. A Kaplan–Meier analysis was used to determine the impact of pre-existing comorbidities on mortality. Pre-existing comorbidities were quantified using the Charlson-Comorbidity Index (CCI). Results: Mean follow-up was 3.3 (range: 1–16; ±3.2) years. There was no evidence of infection persistence in all patients at the one-year follow-up. One patient underwent revision surgery for early local infection recurrence (1.4%). Five (6.9%) patients required an early secondary intervention at the same level due to minor complications. Radiological follow-up revealed implant stability in 70/73 (95.9%) cases. Successful sagittal reconstruction was demonstrated in all patients (<i>p</i> < 0.001). There was a significant correlation between Kaplan–Meier survival and the number of pre-existing comorbidities (24-months-survival: CCI ≤ 3: 100%; CCI ≥ 3: 84.6%; <i>p</i> = 0.005). Conclusions: The Cement-PLIF procedure for pyogenic erosive spondylodiscitis is an effective and safe treatment as evaluated by infection elimination, clinical outcome, restoration, and maintenance of stability and sagittal alignment.https://www.mdpi.com/2306-5354/9/2/73spondylodiscitisPMMApolymethylmethacrylatespinal implantsosteomyelitisbony erosion |
| spellingShingle | Moritz Caspar Deml Emmanuelle N. Cattaneo Sebastian Frederick Bigdon Hans-Jörg Sebald Sven Hoppe Paul Heini Lorin Michael Benneker Christoph Emanuel Albers PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases Bioengineering spondylodiscitis PMMA polymethylmethacrylate spinal implants osteomyelitis bony erosion |
| title | PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases |
| title_full | PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases |
| title_fullStr | PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases |
| title_full_unstemmed | PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases |
| title_short | PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis—A Single-Center Retrospective Study of 73 Cases |
| title_sort | pmma cement plif is safe and effective as a single stage posterior procedure in treating pyogenic erosive lumbar spondylodiscitis a single center retrospective study of 73 cases |
| topic | spondylodiscitis PMMA polymethylmethacrylate spinal implants osteomyelitis bony erosion |
| url | https://www.mdpi.com/2306-5354/9/2/73 |
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