Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: A minimum 2-year follow-up

Ching Yu Lee, Tsung Jen Huang, Yen Yao Li, Chin Chang Cheng, Meng Huang Wu

研究成果: 雜誌貢獻文章

5 引文 (Scopus)

摘要

Background context Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge. Purpose The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years. Study design A retrospective comparative cohort study in a single center. Patient sample Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled. Outcome measures Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria. Methods Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years). Results The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion. Conclusions Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.

原文英語
頁(從 - 到)1099-1105
頁數7
期刊Spine Journal
14
發行號7
DOIs
出版狀態已發佈 - 七月 1 2014
對外發佈Yes

指紋

Spondylitis
Length of Stay
Erythrocyte Transfusion
Critical Care
Drainage
Spine
Thorax
Tissue Adhesions

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

引用此文

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title = "Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: A minimum 2-year follow-up",
abstract = "Background context Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge. Purpose The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years. Study design A retrospective comparative cohort study in a single center. Patient sample Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled. Outcome measures Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria. Methods Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years). Results The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17{\%} and 59{\%} in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97{\%}), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion. Conclusions Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.",
keywords = "Infectious spondylitis, Minimal access spinal surgery, Traditional anterior spinal surgery",
author = "Lee, {Ching Yu} and Huang, {Tsung Jen} and Li, {Yen Yao} and Cheng, {Chin Chang} and Wu, {Meng Huang}",
year = "2014",
month = "7",
day = "1",
doi = "10.1016/j.spinee.2013.07.470",
language = "English",
volume = "14",
pages = "1099--1105",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "7",

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TY - JOUR

T1 - Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis

T2 - A minimum 2-year follow-up

AU - Lee, Ching Yu

AU - Huang, Tsung Jen

AU - Li, Yen Yao

AU - Cheng, Chin Chang

AU - Wu, Meng Huang

PY - 2014/7/1

Y1 - 2014/7/1

N2 - Background context Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge. Purpose The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years. Study design A retrospective comparative cohort study in a single center. Patient sample Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled. Outcome measures Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria. Methods Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years). Results The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion. Conclusions Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.

AB - Background context Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge. Purpose The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years. Study design A retrospective comparative cohort study in a single center. Patient sample Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled. Outcome measures Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria. Methods Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years). Results The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion. Conclusions Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.

KW - Infectious spondylitis

KW - Minimal access spinal surgery

KW - Traditional anterior spinal surgery

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