Sequential or Simultaneous, Same-Day Anterior Decompression and Posterior Stabilization in the Management of Vertebral Osteomyelitis of the Lumbar Spine

Safran, Ori; Rand, Nahshon; Kaplan, Leon; Sagiv, Shaul; Floman, Yizhar

doi:10.1097/00007632-199809010-00018

Cited by 110 publications

(83 citation statements)

References 11 publications

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“…Moon et al [22] suggested that posterior surgery was useful for early control of the disease, early fusion and prevention of kyphosis progression. Safran et al [28] showed that anterior decompression and posterior stabilization at the same day was an effective and safe method of controlling the disease and stabilization of the affected segments. Klockner et al [16] suggested that posterior instrumentation should be combined with anterior debridement and fusion in deformities affecting many levels and/or in excessive kyphotic deformities.…”

Section: Discussionmentioning

confidence: 99%

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

et al. 2010

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We retrospectively studied the cases with tuberculous spondylitis of thoracolumbar region with two or more levels of involvement that underwent posterior instrumentation and fusion and anterior fusion with titanium mesh following anterior decompression using simultaneous successive posterior-anterior-posterior surgery. Among all patients with tuberculous spondylitis accompanied by medium or severe kyphosis, 20 patients who underwent simultaneous successive decompression, fusion and instrumentation with posterior-anterior-posterior surgery between 1999 and 2004 were included in the study. Patients were evaluated for fusion formation and neurological and functional status. Kyphosis angles were measured at early and long-term follow-up. Antituberculosis chemotherapy was initiated in all patients and continued for 9 months; initially as quadruple therapy for 3 months, and then as triple therapy. Average follow-up period was 52.7 months (range 37-94). Solid fusion was achieved in all patients. All patients returned to their previous occupation; 75% (15 subjects) with mild pain or no pain and 15% (3 subjects) with major limitations. There were 11 patients with neurological deficit, 9 of these achieved complete neurological recoveries. Regarding kyphosis angle, an average 35.1°correction (84.8%) was obtained in postoperative period (p \ 0.001) and there was no significant correction loss during the follow-up period (p \ 0.05). There were no grafts or instrumentation-related stabilization problems. In subjects with tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis, decompression, fusion and instrumentation by simultaneous successive posterior-anterior-posterior surgery is an effective and safe management method for effective kyphosis correction with high fusion rates.

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Section: Discussionmentioning

confidence: 99%

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

et al. 2010

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“…These patients usually need to be maintained in bed after surgery, and the duration of bedrest will depend upon the degree of stability achieved at operation. Therefore, addition of posterior instrumentation in a noncontaminated field seems to be a more logical choice of treatment modalities to avoid graft displacement and facilitate early rehabilitation [3,5,10,11,15,19,21,27,31,36,41,46]. In some cases treated with posterior instrumentation, a cyclindrical titanium cage filled with bone graft has been also used as an alternative to structural bone grafting [17,25,28,29,32,36,48].…”

Section: Discussionmentioning

confidence: 99%

Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

2008

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Anterior radical debridement and bone grafting is popular in the treatment of pyogenic infection of the spine, but there remains great concern of placing instrumentation in the presence of infection because of the potentiality of infection recurrence after surgery. The objective of this study was to prospectively evaluate the efficacy and safety of anterior instrumentation in patients who underwent simultaneous anterior debridement and autogenous bone grafting for the treatment of pyogenic vertebral osteomyelitis. The series consisted of 22 consecutive patients who were treated with anterior debridement, interbody fusion with autogenous bone grafting and anterior instrumentation for pyogenic vertebral osteomyelitis of thoracic and lumbar spine. The patients were prospectively followed up for a minimum of 3 years (average 46.1 months; range 36-74 months). Data were obtained for assessing clinically the neurological function and pain and radiologically the spinal alignment and fusion progress as well as recurrence of the infection. All the patients experienced complete or significant relief of back pain with rapid improvement of neurological function. Kyphosis was improved with an average correction rate of 93.1% (range 84-100%). Solid fusion and healing of the infection was achieved in all the patients without any evidence of recurrent or residual infection. The study shows that combined with perioperative antibiotic regimen, anterior instrumentation is effective and safe in the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine directly following radical debridement and autogenous bone grafting.

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“…However, inspired by the methods of surgical management of severe scoliosis in which a combined single-stage operation was routinely used, some surgeons tried to use the single-staged surgery for the treatment of pyogenic vertebral osteomyelitis. The results indicated that single-staged operation also has many advantages such as lower complication rate, shorter hospital stay, and earlier mobilization as compared to its counterpart [13,23,36,70]. In 1988, Redfern and colleagues [67] presented a series of six patients with pyogenic osteomyelitis treated with single-staged debridement and posterior instrumentation.…”

Section: Single-stage or Two-stage Operationmentioning

confidence: 99%

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

2006

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Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection.

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Sequential or Simultaneous, Same-Day Anterior Decompression and Posterior Stabilization in the Management of Vertebral Osteomyelitis of the Lumbar Spine

Cited by 110 publications

References 11 publications

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

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