One-Stage Biopsy, Debridement, Reconstruction, and Stabilization of Pyogenic Vertebral Osteomyelitis

Abstract

Study Design Retrospective cohort study. Objective To evaluate whether the proposed one-stage biopsy, culture, debridement, and reconstruction with stabilization strategy is a viable option for pyogenic vertebral osteomyelitis (PVO). PVO is increasing in frequency globally, particularly in immunologically compromised individuals. Typically, biopsy and culture sensitivity followed by staged surgery and long-term antibiotic therapy is the mainstay of therapy. Methods This is a study of a group of 32 consecutive cases of PVO (spondylodiskitis) treated in our institution from 2010 to 2012. All cases had one-stage biopsy, culture sensitivity, debridement, reconstruction with iliac bone graft, and stabilization with titanium implants. The mean age in this series was 51 years, and the male-to-female ratio was 2.2:1. Approximately 50% of the patients had impaired immunity status. The commonest organism isolated was Pseudomonas aeruginosa. Culture-specific antibiotics were given for a minimum of 6 weeks to all patients. The follow-up period ranged from 6 months to a maximum of 2 years. All patients were assessed for wound healing, recurrence of infection, deformity progression, pain, and healing by radiologic and biochemical parameters. No generic or disease-specific outcome tools were used for this study. Results All patients had good wound healing, although there was one case of superficial infection that was resolved with debridement. There were two implant failures with pseudarthrosis and one localized kyphosis in this series. Conclusions The one-stage technique of biopsy, debridement, bone grafting, and stabilization can be recommended for most cases of PVO.

The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review

“…Prompt diagnosis and targeted treatment are essential to prevent these complications [8]. Moreover, pathogen-directed therapy is necessary to reduce cost, adverse events such as Clostridium difficile infection, relapse, and the emergence of resistant organisms.…”

“…Moreover, pathogen-directed therapy is necessary to reduce cost, adverse events such as Clostridium difficile infection, relapse, and the emergence of resistant organisms. In the absence of life-threatening sepsis or impending spinal cord compression, best practices mandate that empiric antibiotics should not be started before attempts have been made to isolate the pathogen [8]. According to the 2015 Infectious Disease Society of America (IDSA) guidelines, “in patients with neurologic compromise with or without impending sepsis or hemodynamic instability…immediate surgical intervention and initiation of empiric antimicrobial therapy” is recommended [9].…”

“…Open surgical biopsy is considered the gold standard for tissue sampling [8]. However, open surgical biopsies are longer, more invasive, entail higher cost, require more prolonged hospitalization, and carry the risks of general anesthesia and major surgery.…”

Use of Blood Culture Bottles to Incubate Irrigation Water from the Surgical Site May Improve Detection of Causative Organisms in Pyogenic Vertebral Osteomyelitis

“…In adults, when PVO is suspected, an open surgical biopsy is considered the gold standard for tissue sampling [6]. However, the infection area or abscess occurs only at the subchondral bone of the vertebral bodies or in the intervertebral discs.…”

Radiographic Features Associated With Increased Surgical Invasiveness in Pyogenic Vertebral Column Osteomyelitis

“…For reconstructive procedures, there are a range of considerations for the surgeon, including approach to the spine, implant material, and reconstructive techniques. [8][9][10][11][12] Advanced imaging in the form of magnetic resonance imaging (MRI) and computed tomography (CT) is frequently obtained for the diagnosis and surgical planning; however, the utility of disease progression evident on these modalities has not been evaluated as a potential guide for surgical reconstruction. 13,14 The Spinal Instability in Neoplasia Score (SINS) was reported in 2010 as a guide to evaluating stability, or lack of, in metastatic spine disease.…”