[Surgical treatment of spondylitic spine with transpedicular stabilisation]

Widespread use of antibiotics resulted in considerable reduction of spondylitis, but despite that progress there are some cases where conservative treatment has failed. In these patients surgical intervention should be carefully considered. Early surgery in patients with increasing neurological deficits causes the uncertainty which exists in relation to possible complications. Fewer doubts are associated with surgical treatment of late consequences (spine deformity, instability, etc). The goal of this study was to present indications for surgery, operative techniques of transpedicular stabilization and results of treatment of thoracic and lumbar spondylitis.

Clinical analysis includes 18 patients with spondylitis treated in the Department of Neurosurgery and Neurotraumatology University of Medical Sciences in Poznan between 1997 and 2004. There were 7 males (39%) and 11 females (61%) in the study group, and their mean age was 57+/-10 years (range 49-69). Spondylitis within thoracic segments was found in 15 (83%) cases and 3 (17%) patients had spondylitis within lumbar segments. Indications for early surgical intervention included increasing neurological symptoms, spine instability and failed conservative treatment. All patients underwent transpedicular stabilization following medulla and nerve root decompression.

Non-specific inflammation was observed in 14 (78%) cases, and specific inflammation was discovered in 4 (22%) cases (bacteriological and histopathological findings). Very good and satisfactory results were achieved in 16 (89%) patients. Complications occurred in 4 (22%) patients.

Spondylitic spine surgery limits inflammatory reaction, strengthens diagnosis, repairs vertebral column stability and improves neurological condition. Transpedicular stabilization is an effective method of achieving of internal spondylodesis.