Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

Abstract

Anterior radical debridement and bone grafting is popular in the treatment of pyogenic infection of the spine, but there remains great concern of placing instrumentation in the presence of infection because of the potentiality of infection recurrence after surgery. The objective of this study was to prospectively evaluate the efficacy and safety of anterior instrumentation in patients who underwent simultaneous anterior debridement and autogenous bone grafting for the treatment of pyogenic vertebral osteomyelitis. The series consisted of 22 consecutive patients who were treated with anterior debridement, interbody fusion with autogenous bone grafting and anterior instrumentation for pyogenic vertebral osteomyelitis of thoracic and lumbar spine. The patients were prospectively followed up for a minimum of 3 years (average 46.1 months; range 36-74 months). Data were obtained for assessing clinically the neurological function and pain and radiologically the spinal alignment and fusion progress as well as recurrence of the infection. All the patients experienced complete or significant relief of back pain with rapid improvement of neurological function. Kyphosis was improved with an average correction rate of 93.1% (range 84-100%). Solid fusion and healing of the infection was achieved in all the patients without any evidence of recurrent or residual infection. The study shows that combined with perioperative antibiotic regimen, anterior instrumentation is effective and safe in the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine directly following radical debridement and autogenous bone grafting.

Fig. 1

A 57-year-old woman was referred to our hospital with a 6-month history of progressively worsening back pain and episodic fever. Radiological studies showed T7–8 disc space destruction with adjacent vertebral body destruction and kyphotic deformity (a). MRI revealed the typical osteomyelitic changes in the T7 and T8 vertebral bodies along with the prevertebral abscess (b, c). Blood and urine cultures were negative. Through a left thoracotomy a T7 and T8 corpectomy was performed with radical debridement. Anterior plating was applied and the autogenous rib bone grafting done. Three months after operation, the X-rays showed the bony fusion. She remained pain-free at the final follow-up when radiographs showed satisfactory fusion (d, e). No recurrence of the disease was noted in this patient

Fig. 2

This 74-year-old patient had a Bacillus coli urinary-tract infection and back pain for 3 months. Although intravenous antibiotics were given, she developed gradual weakness of the lower extremities (Frankel C) with the temperature persistent above 39°C. A CT scan of the thoracic spine revealed destruction of the T6 and T7 vertebral bodies (a), and MRI scan demonstrated osteomyelitis at T6 and T7 with pre- and paraspinal abscess (b, c). The patient underwent radical debridement, followed by the reconstruction using a titanium mesh cage filled with the crushed autograft rib bone and anterior plating. Back pain improved immediately after surgery with the temperature returned to normal on the third postoperative day. Her weakness was relieved. Solid bone fusion was identified at the final follow-up examination (d, e)