Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

Abstract

Purpose: Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction.

Methods: Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria).

Results: Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up.

Conclusions: Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.

Fig. 1

A 82-year-old woman with post discectomy osteomyelitis of L4-L5 (Patient no. 16). T1-weighted MRI image showed severely narrowed spinal canal due to large epidural abscess (a) while STIR MRI image showed L4-L5 disc infection (b). Comparison of immediate (c) and late postoperative X-rays (d) showed slight posterior migration of cage. Large fusion mass occurred anteriorly (d). CT image also confirmed anterior fusion mass extending to also L5-S1 disc space (e)

Fig. 2

A 72-year-old man with osteomyelitis of Th6-Th7-Th8 (Patient no. 11). T2-weighted MRI image preoperatively showed Th7-Th8 deformation and spinal canal narrowing (a). Late postoperative AP (b) and lateral (c) X-rays showed solid bony fusion over three affected segments

Fig. 3

A 58-year-old woman with vertebral osteomyelitis of Th12-L1 and large epidural abscess formation (Patient no. 1). Preoperative lateral X-ray (a), preoperative sagittal T1-weighted MRI (b). AP and lateral X-rays (c, d) 12 months postoperatively demonstrated solid bony fusion