Anterior and posterior approaches for removal of infected lu
The aim of this study was to investigate the surgical management of cage infection after lumbar interbody fusion. In cases of postoperative deep wound infection after interbody fusion with cages, it is often difficult to decide whether to preserve or remove the cages, and there is no consensus on the optimal approach for removing cages.

A retrospective study was conducted in which patients were included if they had postoperative deep wound infection and required cage removal. Clinical outcomes, including operative parameters, visual analog scale, neurologic status, and fusion status, were assessed and compared between anterior and posterior approaches for cage removal.

Results:
--Of 130 patients who developed postoperative infection and required surgical debridement, 25 were diagnosed with cage infection.

--12 underwent an anterior approach, while 13 underwent cage removal with a posterior approach.

--Significant differences were observed between the anterior and posterior approaches in elapsed time to the diagnosis of cage infection, operative time, and hospital stay.

--All patients had better or stationary American Spinal Injury Association impairment scale, but one case of recurrence in adjacent disc 3 months after the surgery.

Conclusively, both the anterior and posterior procedures for cage removal were possible with promising results followed by interbody debridement and fusion with bone grafts. An earlier approach generally requires further extension of the rear instrument due to the high occurrence of concomitant pedicles. The employment of an endoscope-supported technology for safe removal of the cages is suggested.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02535-x
Like
Comment
Share