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. 2024 Jan 4;13(1):296.
doi: 10.3390/jcm13010296.

Anterior Column Reconstruction of Destructive Vertebral Osteomyelitis at the Thoracolumbar Spine with an Expandable Vertebral Body Replacement Implant: A Retrospective, Monocentric Radiological Cohort Analysis of 24 Cases

Lisa Klute  1 , Marie Esser  1 , Leopold Henssler  1 , Moritz Riedl  1 , Melanie Schindler  1 , Markus Rupp  1 , Volker Alt  1 , Maximilian Kerschbaum  1 , Siegmund Lang  1
Affiliations

Anterior Column Reconstruction of Destructive Vertebral Osteomyelitis at the Thoracolumbar Spine with an Expandable Vertebral Body Replacement Implant: A Retrospective, Monocentric Radiological Cohort Analysis of 24 Cases

Lisa Klute et al. J Clin Med. .

Abstract

Background: Vertebral osteomyelitis (VO) often necessitates surgical intervention due to bone loss-induced spinal instability. Anterior column reconstruction, utilizing expandable vertebral body replacement (VBR) implants, is a recognized approach to restore stability and prevent neurological compromise. Despite various techniques, clinical evidence regarding the safety and efficacy of these implants in VO remains limited.

Methods: A retrospective cohort analysis, spanning 2000 to 2020, was conducted on 24 destructive VO cases at a Level 1 orthopedic trauma center. Diagnosis relied on clinical, radiological, and microbiological criteria. Patient demographics, clinical presentation, surgical interventions, and radiological outcomes were assessed.

Results: The study included 24 patients (62.5% male; mean age 65.6 ± 35.0 years), with 58% having healthcare-associated infections (HAVO). The mean radiological follow-up was 137.2 ± 161.7 weeks. Surgical intervention significantly improved the bi-segmental kyphotic endplate angle (BKA) postoperatively (mean -1.4° ± 13.6°). However, a noticeable loss of correction was observed over time. The study reported a mortality rate of 1/24.

Conclusions: Anterior column reconstruction using expandable VBR effectively improved local spinal alignment in destructive VO. However, the study underscores the necessity for prolonged follow-up and continuous research to refine surgical techniques and postoperative care. Addressing long-term complications and refining surgical approaches will be pivotal as the field progresses.

Keywords: anterior column reconstruction; bony fusion rate; expandable vertebral body replacement; spondylodiscitis; vertebral osteomyelitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Measurement of the bi-segmental kyphotic endplate angle (BKA) in medio-lateral X-rays.
Figure 2
Figure 2
Inclusion and exclusion criteria of study cohort.
Figure 3
Figure 3
BKA changes of the total cohort (n = 24).
Figure 4
Figure 4
Changes in the BKA in the Thoracic Spine (A), the Thoracolumbar junction (B), and the Lumbar Spine (C).
See this image and copyright information in PMC

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