Neurosurgical Management of Thoracic and Lumbar Vertebral Osteomyelitis and Discitis in Adults: A Review of 43 Consecutive Surgically Treated Patients

Abstract

We report 43 consecutive surgically treated patients with pyogenic (37 patients) and tuberculous (6 patients) osteomyelitis of the thoracic and lumbar spine encountered within an 8-year period, including 1 with late recurrence after 15 months. There were 24 men and 18 women, ranging in age from 21 to 83 years. Twenty-six patients were in poor general condition because of associated illnesses, especially diabetes mellitus. Disease occurred at the thoracic level in 19 patients and on the lumbar spine in 24. After diagnosis, five patients were merely treated by posterior decompression; three of them, however, required further surgery for recurrent infection, spinal instability, and secondary neurological impairment. They are included in the 40 patients who underwent combined posterior débridement and internal fixation with transpedicular screw-rod systems. Autologous interbody bone grafting was performed simultaneously in 18 patients and in a second stage operation in 21 patients. One of them (tuberculous) experienced early recurrence and required anterior fusion. In two patients, methylmethacrylate packing was used for spine reconstruction; one of them had a late recurrence. Of the 26 patients with preoperative marked or severe neurological deficit (Frankel Grades A, 2 patients; B, 1 patient; C, 17 patients; and D, 6 patients), 23 (88%) had significant improvement of one grade (15 patients) or more (8 patients). There were no permanent complications. However, intensive care treatment was necessary in 20 of the 26 patients in reduced general condition (mean age, 72 yr). Two patients required further surgery because of postoperative epidural hematoma and pedicle screw malpositioning. In conclusion, most patients with thoracic and lumbar osteomyelitis can be successfully treated by combined débridement and internal fixation using only a posterior approach. Autogenous interbody bone grafting can be simultaneously performed and allows early mobilization of the patient.

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

“…(1) Debridement, spinal cord decompression, correction of deformities, bone grafting, and internal fixation can be completed in one incision and surgical position and iatrogenic spinal injury avoided while turning over, which is similar to the best results obtained via anterior decompression [21,22]. (2) Without one-lung ventilation, the interference of pulmonary function is relatively small, and there are fewer postoperative complications such as atelectasis, lung infection, and chylothorax because of fewer traumas.…”

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

“…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].…”

Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report

“…However, in most patients, the ESR drops to less than half of the original value at the completion of antibiotic therapy. Although it has not often been described in literature, Rath et al [7] reported that elevation of the CRP is a more accurate finding in vertebral osteomyelitis. The CRP is also a more constant laboratory finding than ESR and it starts to drop earlier after antibiotherapy according to our experience.…”

“…But the symptoms and signs were not affected, and the ESR and CRP did not drop in spite of the quartet chemotherapy, and the lesion was operated because of huge prevertebral abscess causing disphagia. It is reported that ESR is a useful guide in evaluating response to therapy during the course of the disease in vertebral osteomyelitis [7]. However, in most patients, the ESR drops to less than half of the original value at the completion of antibiotic therapy.…”

“…But Oga et al [6] demonstrated that adhesive properties of Mycobacterium tuberculosis on stainless steel was less than that of other bacteria. Although there were no studies on titanium, there were no Note that there were no new kyphosis on radiographs and no epidural compression on cervical MRI recurrences of infection due to instrumentation in reported series using anterior approach [7,11]. Primary stabilisation of the infected spine by instrumentation may facilitate nursing care, may allow early mobilisation of the patients, and therefore, reduces the risks of the complications of long-term bed rest [7].…”