Anterior Debridement, Fusion, and Extrafocal Stabilization in the Treatment of Osteomyelitis of the Spine

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

“…These patients usually need to be maintained in bed after surgery, and the duration of bedrest will depend upon the degree of stability achieved at operation. Therefore, addition of posterior instrumentation in a noncontaminated field seems to be a more logical choice of treatment modalities to avoid graft displacement and facilitate early rehabilitation [3,5,10,11,15,19,21,27,31,36,41,46]. In some cases treated with posterior instrumentation, a cyclindrical titanium cage filled with bone graft has been also used as an alternative to structural bone grafting [17,25,28,29,32,36,48].…”

“…There has been great concern of placing instrumentation in the presence of infection because of the potentiality of infection recurrence after surgery [31,37,48]. In the current study, the efficacy and safety of anterior instrumentation was prospectively evaluated, in patients who underwent simultaneous anterior debridement and autogenous bone grafting for pyogenic vertebral osteomyelitis of thoracic and lumbar spine, for at least 3 years after surgery.…”

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

“…However, an increasing number of studies advocate a combination of posterior stabilisation and anterior debridement and interbody fusion. The advantages of this technique are better correction of the kyphotic deformity and its maintenance, and earlier patient mobilisation [1,5,7,8,11,14,15,19].…”

“…The reported techniques of surgical treatment range from anterior debridement and interbody fusion [13], debridement and internal fixation from the posterior approach [17] to combined single-stage or twostage posterior instrumentation with anterior debridement and bone grafting [1,5,7,8,11,14,15,19]. Anterior instrumentation or the use of cages has been anecdotally reported, but there is a critical discussion concerning the role of spinal implants in the presence of infection [4,8,19,21].…”

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

“…However, one could object that extensive debridement might result in a further loss of support that requires more extended reconstruction. This objection was quite founded, especially in the past, when, for many years, the golden standard for anterior vertebral reconstruction was represented by the structural autograft [21,22], which remained difficult or impractical for use in many patients with vertebral osteomyelitis due to a number of adverse factors. Fortunately, nowadays, strong alternatives to bone autograft exist.…”