Anterior Debridement and Fusion With Plating for Cervical Spondylodiscitis: Retrospective Assessment of Clinical Efficacy.

Abstract

<h4>Background</h4>Cervical spondylodiscitis is a rare condition that easily causes neurological deficits. This study aimed to evaluate the safety and efficacy of anterior debridement and fusion (ADF) with plating for cervical spondylodiscitis.<h4>Method</h4>We retrospectively analyzed the medical records of 24 patients who underwent ADF with plating and antibiotics for cervical spondylodiscitis at our institution from June 2005 to June 2023. The neurologic status was evaluated using the Japanese Orthopedic Association scoring system and Hirabayashi recovery rate. Radiological parameters were assessed, including C2 to C7 angle, angle and height of the fused segment, and fusion status.<h4>Results</h4>Mean follow-up time was 50.1 (range 12-162) months. The Japanese Orthopedic Association score increased from 13.2 preoperatively to 15.8 at the final follow-up, with a mean Hirabayashi recovery rate of 79.3%. Recovery outcomes were excellent in 17 (70.8%) cases, good in 3 (12.5%), acceptable in 1 (4.2%), and unchanged in 3 (12.5%). Postoperative C2 to C7 angles and the angle and height of the fused segment were significantly improved compared with preoperative measures. However, height loss of the fused segments occurred in all cases during the follow-up period, especially in ADF with titanium mesh. One patient received revision with posterior fixation because of a pathological fracture in the cephalic vertebral body of the fused segment in the early postoperative phase. Infection resolution and solid bony fusion were achieved in all patients.<h4>Conclusion</h4>ADF with plating can achieve satisfactory clinical outcomes for cervical spondylodiscitis.<h4>Clinical relevance</h4>Poor bone quality secondary to infection, excessive intraoperative cervical distraction, and the choice of fusion material may be associated with the loss of fused segmental height and angle, as well as potential instrumentation failure, after ADF with plating.<h4>Level of evidence: 4</h4>