Posterior Approach Alone Versus Combined Anterior and Posterior Approach in Surgical Management of Dorsal or Lumbar Pyogenic Spondylodiscitis:A Systematic Review and Meta-analysis

Abstract

yogenic spondylodiscitis is a spinal infection which affects intervertebral disc, adjacent vertebrae and occasionally also the posterior elements of the spine. There are two main infection routes: hematogenous or non-hematogenous. Staphylococcus aureus is the most common pathogen responsible for pyogenic spondylodiscitis. Diagnosis is based on clinical, laboratory and radiological features. Symptoms of spondylodiscitis include moderate to severe back pain, history of fever, and neurologic deficits. Laboratory tests are usually inconclusive in diagnosing spondylodiscitis. ESR and C-reactive protein levels are more helpful than WBC count. Plain X-ray Imaging of the spine has a low specificity for the evaluation of spondylodiscitis. CT can further characterize bone lesions, as it is more sensitive than plain x-ray. MRI is as sensitive, specific, and accurate modality for evaluating spinal infections. Nuclear imaging is useful for early detection (3-15 days) of spinal infection. When spinal infection is suspected and blood cultures are negative, biopsy should be performed. Conservative therapy often is the primary option for elderly patients, for patients in poor general condition, when clinical symptoms are mild or bony destruction is minimal and for patients with high risks of surgical intervention.