Indication β posterior abscess, no spondylodiscitis
Anterior β debridement and strut grafting
Indication β Anterior abscess, with VB and disc involved
Option of strut β titanium mesh cages, tricortical iliac crest (Auto vs allograft), rib, biular strug graft
Post op - insert drain, continue IV Abx, trend inflammatory markers, multidisciplinary with ID for duration
β£
Can we instrument in same setting if spine is unstable in Spine infection?
Hey et al. 2017. Cohort study of 84 patients. No difference in terms of reop for Abx only vs Abx with debridement vs Abx with debridement with instrumentation.
Postulated that biofilm formation in spine is offset by good blood supply of axial skeleton when compared to the appendicular skeleton
Position - lateral position, can use AMSCO table to break table
Incision - 12th rib and oblique towards the lateral border of the rectus abdominis muscle about 5cm lateral to midline
Superficial Dissection - Skin β Subcut β 3 muscles - EO, IO, TF β Plane between retroperitoneal fat and fascia that overlies the psoas muscle β sweep everything anteriorly β ligate lumbar vessels from aorta to mobilize it anteriorly