Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Abstract

<jats:p>Establishing the diagnosis of cervical osteomyelitis in a timely fashion is critical to prevent catastrophic neurological injury. In the modern imaging era, magnetic resonance imaging in particular has facilitated the diagnosis of cervical osteomyelitis, even before the onset of neurological signs or symptoms. Nevertheless, despite advancements in diagnosis, disagreement remains regarding appropriate surgical treatment. The role of instrumentation and type of graft material after cervical decompression remain controversial. The authors describe the epidemiological features, pathogenesis, and diagnostic evaluation, and the surgical and nonsurgical interventions that can be used to treat osteomyelitis of the cervical spine. They also review the current debate about the role of instrumentation in preventing spinal deformity after surgical decompression for cervical osteomyelitis. Based on this review, the authors conclude that nonsurgical therapy is appropriate if neurological signs or symptoms, instability, deformity, or spinal cord compression are absent. Surgical decompression, debridement, stabilization, and deformity correction are the goals once the decision to perform surgery has been made. The roles of autogenous graft, instrumentation, and allograft have not been clearly delineated with Class I data, but the authors believe that spinal stability and decompression override creating an environment that can be completely sterilized by antibiotic drugs.</jats:p>

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

“…Independently of its origin, cervical osteomyelitis requires surgical intervention in the presence of a neurologic deficit, extensive bony destruction, paravertebral or epidural abscess formation and persistent septicaemia [1,2,12,25]. Anterior debridement and spondylodesis seem to be sufficient in cases without instability and severe deformity [6,10,13], but multisegmental involvement or distinct substance loss requires a combined anterior-posterior approach [10,13,23,24].…”

“…Anterior debridement and spondylodesis seem to be sufficient in cases without instability and severe deformity [6,10,13], but multisegmental involvement or distinct substance loss requires a combined anterior-posterior approach [10,13,23,24]. Most of these reports deal with the thoracic and lumbar spine, but results may be transferred to the cervical spine too [1,2,10,24].…”

“…Osteomyelitis of the cervical spine is a rare event representing 3-6% of vertebral osteomyelitis [1,2,25]. It is mainly caused by haematogenous spread [1,2,5,25,28], but may also occur as a complication of operative procedures [1,2,9,25].…”

“…It is mainly caused by haematogenous spread [1,2,5,25,28], but may also occur as a complication of operative procedures [1,2,9,25]. Therapy consists of operative debridement and stabilization either as a single or multiple stage procedure.…”

“…This is performed via the anterior approach, but it is a matter of debate whether anterior or posterior approaches are sufficient or a 360°stabilization is needed. Combined approaches are advocated in cases with a significant amount of bone destruction [1].…”