Posterior percutaneous fixation without anterior or posterior debridement for infectious spondylitis in high-morbidity patients - A retrospective comparative study

Q: What alternative technique is proposed for high-morbidity infectious spondylitis patients?

The study proposes posterior-only percutaneous pedicle screw fixation without anterior or posterior debridement, termed “internal orthosis.” It aims to reduce invasiveness while maintaining clinical efficacy.

Q: How were the patients grouped in this retrospective comparative study?

Patients who underwent surgery for thoracolumbar infectious spondylitis between 2012 and 2021 were divided into two groups: conventional treatment (anterior debridement plus posterior fixation) and posterior-only fixation without debridement.

Q: What were the main differences in operative outcomes between the groups?

The internal orthosis group showed significantly shorter operative time and reduced intraoperative blood loss. Inflammatory markers and VAS scores improved in both groups over follow-up.

Sep 30, 2026

Uploaded by Mary Man

Standard treatment for infectious spondylitis usually includes anterior debridement and interbody fusion, but in high-morbidity patients it can lead to substantial surgical complications. This retrospective comparative study evaluates a minimally invasive alternative: posterior-only percutaneous pedicle screw fixation without anterior or posterior debridement (“internal orthosis”). Patients undergoing surgery for thoracolumbar infectious spondylitis from 2012 to 2021 were divided into conventional and internal orthosis groups. Forty-five patients were analyzed. The internal orthosis group had markedly shorter operative time and less blood loss, with clinical and laboratory improvements over time. Radiographs showed transient kyphotic change at one month and comparable long-term spinal alignment. Although bone union occurred less often radiologically, clinical success rates were similar, supporting “internal orthosis” as a feasible option for selected high-risk cases.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Surgical background and rationale

Study purpose and controversy

® Observational Study Posterior percutaneous fixation without anterior or posterior debridement for infectious spondylitisin high-morbidity patients A retrospective comparative study Chan Young Lee, MDa , Sung-Kyu Kim, MD, PhDb , Hyoung-Yeon Seo, MD, PhDb ,* | Abstract
Standard surgical treatment for infectious spondylitis involves anterior debridement and interbody fusion. However, for patients with high morbidity, this may result in many complications. We propose an alternative technique – posterior-only percutaneous pedicle screw fixation without anterior or posterior debridement (“internal orthosis”)– to reduce surgical invasiveness while maintaining clinical efficacy. We retrospectively compare the outcomes between conventional and internal orthosis procedures. This retrospective comparative study included patients who underwent surgery for thoracolumbar infectious spondylitis between 2012 and 2021. Patients were divided into 2 groups according to surgical technique: conventional treatment with anterior debridement and posterior fixation, and posterior-only fixation without any debridement. Clinical outcomes (visual analog scale [VAS] score and success rate), laboratory markers (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein), and radiologic parameters (kyphotic/lordotic angle and bone union) were evaluated during follow-up. A total of 45 patients were included in the study (22 in the conventional group and 23 in the internal orthosis group) . The internal orthosis group demonstrated significantly shorter operative time (202 ± 71 minutes vs 376 ± 126 minutes, P < .001) and reduced intraoperative blood loss (267 ± 122 mL vs 646 ± 460 mL, P < .001) compared with the conventional group. Inflammatory markers and VAS score improved significantly over time in both groups. Radiologic analysis showed a transient increase in kyphotic angle in the internal orthosis group at one month, although long-term spinal alignment remained stable in both groups. While the conventional group demonstrated a higher rate of radiologic bone union (86 .4% vs 43.5%, P = .003), the internal orthosis group achieved similar clinical success, with rates of 95.5% and 87.0%, respectively (P = .608) . No other significant group differences were identified in laboratory or radiologic parameters. “Internal orthosis” can be an alternative treatment option for high-risk patients with infectious spondylitis. Despite a lower rate of radiological fusion, clinical outcomes were comparable, suggesting its potential as a truly minimally invasive strategy in selected cases. | | --- | | Abbreviations: CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, VAS = visual analog scale, WBC = white blood cell count. | | Keywords: high morbidity, infectious spondylitis, minimally invasive spine surgery, percutaneous pedicle screw fixation | 1. Introduction Infectious spondylitis is a rare but serious condition with an increasing incidence, reported as 2.4 to 6.5 cases per 100,000 persons annually, and is associated with considerable morbidity and mortality.[1,2] Recent epidemiologic analyses have demonstrated that the in-hospital mortality rate ranges from 1.8 to 5.5% within one year, and may reach up to 45% at long-term follow-up, highlighting the substantial clinical burden of this disease. [3] Despite advances in antibiotics and surgical techniques, controversy persists regarding the optimal surgical strategy for high-risk patients. [4–6] In infectious spondylitis, the anterior column is most commonly affected; therefore, anterior debridement with tricortical This study was financially supported by Chonnam National University (Grant number: 2025-0367-01). The authors have no conflicts of interest to disclose. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. This study was approved

FAQs

What alternative technique is proposed for high-morbidity infectious spondylitis patients?

The study proposes posterior-only percutaneous pedicle screw fixation without anterior or posterior debridement, termed “internal orthosis.” It aims to reduce invasiveness while maintaining clinical efficacy.

How were the patients grouped in this retrospective comparative study?

Patients who underwent surgery for thoracolumbar infectious spondylitis between 2012 and 2021 were divided into two groups: conventional treatment (anterior debridement plus posterior fixation) and posterior-only fixation without debridement.

What were the main differences in operative outcomes between the groups?

The internal orthosis group showed significantly shorter operative time and reduced intraoperative blood loss. Inflammatory markers and VAS scores improved in both groups over follow-up.

Sep 30, 2026

Uploaded by Mary Man