Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis

Abstract

AIMTo evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage (TaMC) followed by immediate instrumentation.METHODSSingle-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score (VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky’s criteria.RESULTSThe average VAS score significantly decreased after the surgery (from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery (P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky’s criteria and significant improvement after the surgery (P < 0.001). No implant breakage or TaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSIONSingle-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

Autogenous Bone Grafts versue Metal Cage with Allogenic Bone Grafts for Post-Corpectomy Anterior Column Reconstruction in Patients with Infectious Spondylitis

“…Patients with infectious spondylitis are treated with radical debridement followed by anterior column reconstruction us- ing various biological and mechanical spacers, including autografts, allografts, and metal cages 23) . The defect created after debridement is commonly repaired using autogenous bone grafts from the fibula or the iliac crest.…”

“…Several biological and mechanical spacers such as allografts, autografts, and metal cages are used for post-corpectomy anterior column reconstruction. To date, reconstruction using a metal cage with allogenic bone grafts after radical debridement of the lesion is controversial 23) .…”

Current Advances and Applications of Tantalum Element in Infected Bone Defects

“…Porous Ta implants were shown to be effective in the second-stage revision of prosthesis infection and the treatment of infectious spondylitis . Upon performing a retrospective analysis of 20 patients who underwent structural reconstruction with a tantalum mesh cage (TaMC) due to infectious spondylitis, it was found that the application of TaMC could significantly improve the function of the patients, with only one patient developing refractory infections that required further debridement (Figure A) . In another study, the data from 60 patients who underwent second-stage revision with porous Ta cones due to knee prosthesis infection indicated that the implantation of porous Ta cones significantly improved the functional scores (Figure B) .…”

“…80 Upon performing a retrospective analysis of 20 patients who underwent structural reconstruction with a tantalum mesh cage (TaMC) due to infectious spondylitis, it was found that the application of TaMC could significantly improve the function of the patients, with only one patient developing refractory infections that required further debridement (Figure 7A). 80 In another study, the data from 60 patients who underwent second-stage revision with porous Ta cones due to knee prosthesis infection indicated that the implantation of porous Ta cones significantly improved the functional scores (Figure 7B). 79 There were only two (3.3%) unsuccessful cases resulting from the recurrence of infection, and neither were related to porous Ta cone mechanics.…”

“…(A) Single-stage anterior radical debridement and Ta mesh cage implantation to treat infectious spondylitis and correct kyphotic deformity. Adapted with permission from ref . Copyright 2017 Baishideng Publishing Group.…”