Safety of instrumentation in patients with spinal infection

Abstract

Instrumentation of the spine is safe and has an important role in stabilization of the infected spine. Despite the presence of active infection, we believe that instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing.

Antibiotic-impregnated polymethylmethacrylate as an anterior biomechanical device for the treatment of cervical discitis and vertebral osteomyelitis: technical report of two cases

“…The concerns with using autologous graft include donor site complications, lack of graft availability due to previous harvest and, as seen in one of our cases, graft dislodgement (13,19). This has led to the use of various allografts including titanium, stainless steel and polyetheretherketone (PEEK) cages (18,22). Allograft use for pyogenic osteomyelitis is gaining wider acceptance with studies from multiple centers refuting concerns that foreign material may lead to persistent infection and construct failure (1,4,10,11,18,20,22,24).…”

“…This has led to the use of various allografts including titanium, stainless steel and polyetheretherketone (PEEK) cages (18,22). Allograft use for pyogenic osteomyelitis is gaining wider acceptance with studies from multiple centers refuting concerns that foreign material may lead to persistent infection and construct failure (1,4,10,11,18,20,22,24). However, these implants come at an increased cost that may not be financially feasible in surgical arenas across the world.…”

“…Cervical DVO with symptoms of neurologic compromise, radiographic structural instability or intolerable pain from failed medical treatment warrants surgical intervention (1,4,7,10,11,18,22,24) (Table II). When reconstructing the cervical spine in cases involving pyogenic osteomyelitis, the most accepted technique is reconstruction with autologous iliac crest graft often performed in a two-step anterior procedure (10,13,15).…”

“…Options range from conservative management, including bracing and antibiotics, to aggressive debridement and primary reconstruction (1,11,13,24). Although gaining wider acceptance and support in the literature, the use of structural allografts and instrumentation in DVO remains controversial (1,18,22). This is primarily based on the perceived risk of persistent infection related to a devitalized graft and adjunctive use of spinal implants that in turn raises concerns of construct failure.…”

Multiple recurrent postoperative spinal infections due to an unrecognized presacral abscess following placement of bicortical sacral screws: case report

“…2,6,9 Although instrumentation does markedly increase the risk of infection, it is often necessary when the patient's spine requires stabilization. 1,14,19,20 Bicortical screws are a good example of this: by breaching 2 segments of cortical bone, these screws offer a greater degree of stability than do monocortical screws. 5,13,21 This is especially important at the lumbosacral junction when a long fusion lever arm is present.…”