gms | German Medical Science

Objective: Despite improved diagnostic methods aggressive therapeutic strategies in cases with spondylodiscitis remains possible life threatening problem. The “gold standard” surgical procedure combines local debridement, bone strut or titanium implant insertion combined with ventral or dorsal instrumentation. For unknown reasons PEEK cages, very popular in degenerative spine surgery, are still uncommon as an alternative spacer in the treatment of pyogenic vertebral infections.

Methods: We retrospectively analysed the data of 15 patients suffering from different neurological deficits caused by pyogenic cervical (n=6) or lumbal spondylodiscitis (n=9). In the cervical spine the infection was limited to the disc without relevant bony destruction of the adjacent endplates and without instability on preoperative flexion – extension films. These patients were treated with debridement of the infected disc and a PEEK Cage as intervertebral spacer alone. The patients suffering from a lumbar discitis were treated with an additional dorsal instrumentation.

Results: Staphylococcus species were the most frequent triggering germ (n=14). All patient were treated postoperatively with antibiotics according to the micobiological data. The postoperative follow-up was performed in our outpatient department including regular clinical MRI, CT and laboratory examinations at every presentation. Bony fusion on CT and complete regression of the inflammatory changes on MRI was achieved after seven to eight months with only moderate changes of the vertebral alignement and average cage subsidence of 2 mm. The clinical symptoms improved in all patients.

Conclusions: This study shows for the first time the feasibility to implant PEEK cages also patients suffering from pyogenic spondylodiscitis. Especially in the cervical spine the surgical procedure is less complex and there are no problems from a donor site compared with iliac bone grafting.