Abstract
Introduction Infection of posterior instrumentation supposes a severe failure in long arthrodeses with a demineralized skeleton.
Materials and methods From 1998 to 2002, ten patients of 19 to 76 years (mean 56 years) have been grafted with anterior Peek cages filled with autograft.
Four cases of scoliosis were operated as an average 5 times by posterior approach (3 – 9 times), all of them suffered fistulised non-unions recidivating after every one of the previous operations. 4 times the germ xas a Staph. Aureus Met. resist (1 associated with a streptococcus and 2 of them with an enterococcus). Three patients presented severe radicular pain.
Six posttraumatic cases underwent a surgical extraction of the posterior instrumentation. All of them presented a non-union with total loss of the initial angular correction. In one case the septic destabilisation affected the level proximal to the fixation. The germ responsible was every time a Staph. Aureus Met. Res. with an enterococcus associated in one of the cases.
Two inveterate fistulae were operated before. The grafts were performed on 1 to 4 levels without a new posterior fixation but in one case (5 thoracolumar approaches, 5 on lumbosacral fusions, external support by a 3 points corset between 4–6 months). The postoperative antibiotherapy has been maintained for 4 months in average (3–12 mos). The fusion was appreciated by the graft aspect on CT scan with a mean follow-up of 22 months (12 months minimum).
Results: No anterior infection has been observed, but in one post-traumatic case with a violation of the discal space by a screw. (Flare-up of the infection without anterior collection, treated by a new posterior approach with definitive kyphotic fusion as a result). All the nine others fused with clinical improvement (sevrance of the rigid corset and decreasing analgesic doses in a mean time of six months) and without significant correction loss. Three cases of radicular pain improved too. As a complication, one female patient previously operated three times by an anterior approach, was operated a new by a minimal left approach without incidents. She suffered in the postoperative period an ureteral necrosis needing a secondary nephrectomy.
Conclusion This strategy of intersomatic graft is a recovering solution in the mechanical failures of severe and reccurrent infections, often germs association. With these severe deformities on aged patients this technique is more difficult. The positive culture of disc material is a bad prognostic factor. In case of previous anterior approach, it is a good procedure the catheterisation of the ureteral duct to prevent a possible necrosis. The intersomatic cage has been a safe procedure assuring a primary and late stability in those patients with a deficient bone-stock. The cages did not induced any additionnal septic problems.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
