Surgical Management of Spontaneous Thoracic and Lumbar Spondylodiscitis via Posterior Debridement and Long-Segment Fixation: A Retrospective Case Series

Introduction: Spontaneous thoracic and lumbar spondylodiscitis (STLS) is an increasing clinical challenge. While conservative treatment is the mainstay, surgical intervention is required for instability or neurological deficits. The optimal approach- posterior-only versus combined- remains a subject of debate. Objective: To evaluate the clinical, neurological, and microbiological outcomes of a surgical strategy centered on posterior transpedicular debridement and long-segment instrumented fixation. Methods: We retrospectively analyzed 20 consecutive patients with STLS treated between 2018 and 2023. All patients underwent posterior-only decompression, aggressive debridement, and long-segment stabilization (typically 2 levels above and below). Outcomes were measured via the Visual Analog Scale (VAS), modified MacNab criteria, and the American Spinal Injury Association (ASIA) Impairment Scale. Results: The mean age was 58.7 years. The lumbar spine was the most common site (70%). Staphylococcus aureus was the primary pathogen (25%), while 25% of cases were culture-negative. Post-operatively, the mean VAS score improved to 3.1, and 70% of patients achieved a satisfactory functional outcome (Excellent/Good) per MacNab criteria. Of the 16 patients presenting with pre-operative neurological deficits, 50% (n=8) showed an improvement of at least one ASIA grade. The overall major complication rate was 25%, including two cases of recurrent infection. Conclusion: Posterior debridement and long-segment fixation provide a reliable means of achieving mechanical stability and neurological recovery in STLS. This approach effectively eradicates the infectious focus while minimizing the morbidity associated with anterior surgery.