Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis

Tung Yi Lin, Tsung Ting Tsai*, Meng Ling Lu, Chi Chien Niu, Ming Kai Hsieh, Tsai Sheng Fu, Po Liang Lai, Lih Huei Chen, Wen Jer Chen

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

38 Scopus citations


Background: Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis. Methods: We retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed. Results: The average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores. Conclusions: Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.

Original languageEnglish
Article number443
JournalBMC Musculoskeletal Disorders
Issue number1
StatePublished - 2014

Bibliographical note

Publisher Copyright:
© 2014 Lin et al.


  • Anterior interbody fusion
  • Minimally invasive surgery
  • Percutaneous pedicle screw
  • Pyogenic spondylodiscitis


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