الفهرس 
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Abstract
This study combines retrospective and Prospective part was conducted on 25 patients with pyogenic lumbar spondylodiscitis underwent Transforaminal Lumbar Thorough Debridement and Spondylodesis (TLTDS) in Minia university hospital. The current study included two parts.
1- Retrospective section involved 15 patients who underwent TLTDS from January 2014 till August 2016.
2- Prospective section introduced to this study from September 2016 to July 2018 each was followed for at least 12 months.
Patients were followed up regularly at 2 weeks, 1m, 3m, 6m and1 year respectively to evaluate the results clinically, radiologically, functional outcome and complication.
The data thus collected from patients was analyzed, evaluated, and the observations were recorded. Our aim was to evaluate the result of Transforminal Lumbar Thourgh Debridemint and Spondylodesis (TLTDS) in management of patients with lumbar pyogenic spondylodiscitis.
All the patients were examined clinically, neurologically and radiological, including detail history of pre morbid status at the time of admission. Patients fulfilling the inclusion criteria was only included in the study.
Of these 25 patients (14 men and 11 women). Mean age was 46.6±10.6 years (range 20-65 years). There was a male predominance. A male represents 56% of our cases. Most common mode of infection was haematogenous spread (60%), iatrogenic (secondary or following spinal procedure) (40%) of cases. The most common pathogen staph aureus (32%), followed by staph epidermideis (24%).
In this study, the most affected level is L4/5 (11 cases). In present study series about (64%) of the patients had associated illness. Most of them have D.M in 11cases (44%), patient with CRF on dialysis 3 cases (12%), 2 cases have compensated liver diseases and 9 cases have no comorbid illness at all. The pre-operative neurologic status was ASIA B in one patient, ASIA C in eight patients; ASIA D in seven patients and ASIA E in nine patients. Nineteen patients returned to ASIA E and six patients to ASIA D at final follow up.
Deep wound infection occurred in two patient debridement was done and the case were good at finial follow up dural tear in one patient and misplaced screw which needed reinsertion. Superficial would infection was seen in two cases. They were female patients, diabetic and were obese. No deaths occurred.
Surgical debridement through transformational and interbody fusion by mesh cage or fibro carbon cage or bone graft and transpedicular fixation was done in all patients. The mean VAS score of back pain improved from 6.2 ± 2.38 pre-operatively to 3.04 ± .79, 2.16 ±, 74, 1.64 ±.56 and 1.13 ±.35 at 3, 6 months, and 1 year post-operatively, respectively.