Related Experiment Video
Updated: May 8, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Secondary changes in sagittal alignment after instrumented surgery with and without corpectomy for pyogenic
B Younes1, B Schatlo1, P Melich1,2
1Dept. of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Objective:
Pyogenic spondylodiscitis is associated with substantial morbidity and mortality, and vertebral body destruction may lead to secondary spinal deformity. However, there is no consensus regarding the indication for 360° fusion compared with stand-alone posterior instrumentation. This study evaluated postoperative changes in sagittal alignment and compared radiological outcomes between these surgical strategies.
Methods:
Data from 90 patients who underwent instrumented surgery for pyogenic spondylodiscitis between 2013 and 2020 were retrospectively analyzed. The primary radiological endpoint was the Cobb angle at the last radiological follow-up (12 months), compared with preoperative and immediate postoperative measurements. Continuous variables are presented as mean ± standard deviation. Univariate and multivariable regression analyses were performed to identify factors associated with alignment changes.
Results:
Posterior instrumentation was performed in 65 lumbar and 25 thoracic cases; 360° fusion was performed in 9 lumbar and 11 thoracic cases. The mean clinical follow-up duration was 24 ± 3 months. In lumbar cases, mean Cobb angles were 26.4 ± 15.8° preoperatively, 28.9 ± 16° postoperatively, and 24.7 ± 14.2° at follow-up. Lordosis increased after surgery but decreased at follow-up (P = 0.034 and P = 0.001, respectively). In thoracic cases, mean Cobb angles were -12.3 ± 6.7°, -11.1 ± 7.1°, and -16.3 ± 9.1°, respectively, with no postoperative improvement and significant kyphosis progression at follow-up (P = 0.211 and P = 0.001, respectively). In lumbar cases, 360° fusion was associated with better sagittal alignment at last follow-up (p = 0.045) and remained an independent predictor in multivariable analysis (p = 0.038). In thoracic cases, the number of operated levels was associated with improved alignment (p = 0.048).
Conclusion:
Secondary changes in sagittal alignment may occur after surgery for pyogenic spondylodiscitis. A 360° fusion may provide greater long-term sagittal stability in the lumbar spine, while posterior instrumentation alone appears sufficient in the thoracic spine.
