Beneficial Influence of Titanium Mesh Cage on Infection Healing and Spinal Reconstruction in Hematogenous Septic Spondylitis

Korovessis, Panagiotis; Repantis, Thomas; Iliopoulos, Panagiotis; Hadjipavlou, Alexander

doi:10.1097/brs.0b013e318187875e

Cited by 96 publications

(82 citation statements)

References 48 publications

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“…It is also obvious that the failure of conservative measures, compression of neural elements, mechanical derangement (instability, malalignment, severe bone destruction), and intractable pain demands surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment and correction of instability [7,8,18]. However, surgeons still discuss staging, surgical access, and usage of instrumentation or cages [3,14,15,20]. Furthermore, minimally invasive and endoscopic surgeries are being promoted [9,11].…”

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confidence: 99%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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Purpose and methods We reviewed the management, failure modes, and outcomes of 196 patients treated for infectious spondylodiscitis between January 1, 2000 and December 31, 2010, at the Spinal Unit, Aarhus University Hospital, Aarhus, Denmark. Patients with infectious spondylodiscitis at the site of previous spinal instrumentation, spinal metastases, and tuberculous and fungal spondylodiscitis were excluded. Results Mean age at the time of treatment was 59 (range 1-89) years. The most frequently isolated microorganism was Staphylococcus aureus. The lumbosacral spine was affected in 64 % of patients and the thoracic in 21 %. In 24 % of patients, there were neurologic compromise, four had the cauda equina syndrome and ten patients were paraplegic. Ninety-one patients were managed conservatively. Treatment failed in 12 cases, 7 patients required re-admission, 3 in-hospital deaths occurred, and 5 patients died during follow-up. Posterior debridement with pedicle screw instrumentation was performed in 75, without instrumentation in 19 cases. Seven patients underwent anterior debridement alone, and in 16 cases, anterior debridement was combined with pedicle screw instrumentation, one of which was a two-stage procedure. Re-operation took place in 12 patients during the same hospitalization and in a further 12 during follow-up. Two in-hospital deaths occurred, and five patients died during follow-up. Patients were followed for 1 year after treatment. Eight (9 %) patients treated conservatively had a mild degree of back pain, and one (1 %) patient presented with mild muscular weakness. Among surgically treated patients, 12 (10 %) had only mild neurological impairment, one foot drop, one cauda equine dysfunction, but 4 were paraplegic. Twenty-seven (23 %) complained of varying degrees of back pain. Conclusions Conservative measures are safe and effective for carefully selected patients without spondylodiscitic complications. Failure of conservative therapy requires surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment, and correction of instability. Surgeons should master various techniques to achieve adequate debridement, and pedicle screw instrumentation may safely be used if needed.

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confidence: 99%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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“…This is true for the thoraco-lumbar region [7,14,16,18,19,24], as well as for the cervical spine [15][16][17]24]. Furthermore, a direct comparison between autologous iliac bone strut and cages did not show a difference in clinical and imaging outcomes [22].…”

Section: Discussionmentioning

confidence: 93%

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

et al. 2010

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Osteomyelitis of the cervical spine may lead to profound bony destruction. The presented case developed multilevel osteomyelitic destruction of the cervical spine after decompression due to cervical myelopathy. He could be cured by a multiple-stage procedure: step one: debridement and removal of all anterior implants with vacuum-assisted closure combined with dorsal instrumentation from C0 to T3; step two: anterior reconstruction with expandable titanium cages and plate. The patient regained walking with the aid of a walking frame. The following recommendations are given: multiple stage procedure, extensive debridement and stabilization via an anterior and posterior approach, use of titanium implants.

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“…There has been a long lasting debate on whether instrumentation in spondylodiscitis patients increases their risk of persistent infection by providing a scaffold for biofilm formation and thus reducing antibiotic effectiveness (Korovessis et al, 2008). Titanium mesh cages though appear to be a safe choice since titanium has been shown to be less prone to bacterial colonization than stainless steel (Chang and Merritt, 1991).…”

Section: Resultsmentioning

confidence: 99%

“…The usual need for a corpectomy during the operation makes the stable reconstruction of the anterior column of the spine imperative. The use of titanium mesh cages and most recently expandable cages through an anterior approach has revolutionaries this process (Korovessis et al, 2008;Hee et al, 2002;Kuklo et al, 2006;Liljenqvist et al, 2003;Fang et al, 1994;Altman et al, 1996;Bhat et al, 1999;Auguste et al, 2006;Arts and Peul, 2008). In an effort to minimize the morbidity associated with the anterior approach, we report to the best of our knowledge the first case of vertebral osteomyelitis to be treated with an extracavitary approach.…”

Section: Introductionmentioning

confidence: 91%

“…Despite the fact that salmonella spondylodiscitis accounts for less than 0.5% of all bone infections, it causes significant difficulties in management and can be associated with increased morbidity and mortality for it usually eludes timely diagnosis (Ozturk et al, 2006;Korovessis et al, 2008). Although it is usually managed with intravenous antibiotics, surgical intervention is indicated in cases of neurological compromise, spinal deformity and concomitant epidural abscess (Arnold et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

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A Case of Refractory Salmonella Spondylodiscitis in an Immunocompetent Patient Treated Via an Extracavitary Approach, Corpectomy and Placement of Expandable Cage

Bekelis¹

2010

American Journal of Infectious Diseases

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Problem statement: Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell disease or immunosuppression. However, it can also be found in immunocompetent patients. It usually responds well to proper antibiotics. However, surgery is rarely indicated when the infection is refractory to antibiotics, the spine is destabilized or there is an epidural component that is compressing the thecal sac and causing neurological deficit. We report the case of a 60 year-old African American woman with borderline diabetes mellitus controlled with diet, who presented with Salmonella osteomyelitis of the thoracic spine that was associated with an epidural abscess. Approach: The patient presented to an outside hospital with diarrhea, fever and chills. This occurred after eating a chicken sandwich. Stool and blood cultures were positive for Salmonella. Initially she was placed on triple antibiotics (ceftriaxone, vancomycin and levofloxacin) and was later switched to levofloxacin alone given that the bacteria were sensitive to this drug. Several weeks later, she presented with severe back pain. Imaging studies showed a significant lytic lesion in her thoracic spine at T11-12 with an epidural component. Given the instability of the lesion and the failure of medical treatment a decision was made for surgical intervention. Results: She underwent an extracavitary approach for partial T11-T12 corpectomies and fusion with instrumentation with continuous administration of the proper antibiotics. The patient was then discharged to an acute patient rehabilitation center. Postoperatively, she was able to ambulate with full strength in her extremitiesand her back pain had resolved. Conclusion/Recommendations: To the best of the authors' knowledge this is the first reported case of Salmonella spondylodiscitis in an immunocompetent patient treated with a corpectomy via an extracavitary approach with the use of an expandable cage and posterior instrumentation.

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Beneficial Influence of Titanium Mesh Cage on Infection Healing and Spinal Reconstruction in Hematogenous Septic Spondylitis

Cited by 96 publications

References 48 publications

Failure modes in conservative and surgical management of infectious spondylodiscitis

Failure modes in conservative and surgical management of infectious spondylodiscitis

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

A Case of Refractory Salmonella Spondylodiscitis in an Immunocompetent Patient Treated Via an Extracavitary Approach, Corpectomy and Placement of Expandable Cage

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