Single-Stage Treatment of Pyogenic Spinal Infection With Titanium Mesh Cages

Kuklo, Timothy R.; Potter, Benjamin K.; Bell, Randy S.; Moquin, Ross R.; Rosner, Michael

doi:10.1097/01.bsd.0000203945.03922.f6

Cited by 110 publications

(93 citation statements)

References 27 publications

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“…Revision was necessary in 1 patient. Kuklo et al (2006) implanted titanium-mesh cages in 22 patients with spondylodiscitis. All patients with additional posterior instrumentation had only minimal settling of the cage.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, more and more spinal surgeons implant metal devices into the infected spine to avoid secondary deformity, regardless of the bacterial adherence that has sometimes been reported. Several authors have recently presented favorable results regarding healing and avoidance or correction of deformity using titanium implants (Heyde et al 2006, Kuklo et al 2006, Ruf et al 2007. In large anterior defects after severe spondylitis, the use of anterior titanium cages is especially advantagious in reconstruction of the sagittal alignment (Robinson et al 2008).…”

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confidence: 99%

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Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

et al. 2008

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Background and purpose The use of metal implants in large defects caused by spinal infection to support the anterior column is controversial, and relatively few results have been published to date. Despite the fact that there is bacterial adhesion to metal implants, the strong immunity of the highly vascularized spine because of rich muscle covering is unique. This possibly allows the use of metal implants, which have the advantage of high stability and reduced loss of correction. This is a retrospective study of patients with spondylodiscitis treated with metal implants.Patients and methods We retrospectively analyzed the outcome in 22 consecutive patients (mean age 69 (43-82) years, 15 men) with spondylodiscitis (20 lumbar and 12 thoracic discs) who had received an anterior titanium cage implantation. In 13 cases, the pathogen could be identified. Antibiotic treatment was continued for at least 12 weeks postoperatively.Results The mean follow-up was 36 (32-47) months. Healing of inflammation was confirmed by clinical, radiographic, and laboratory parameters. The mean VAS improved from 9.1 (6-10) preoperatively to 2.6 (0-6) at the final follow-up, and the mean Oswestry disability index was 17 (0-76) at the final follow-up.Interpretation Our findings highlight the high healing rate and stability when titanium implants are used. Prerequisites are a radical debridement, correction of deformity, and additional bony fusion by bone grafting. The increased stability, with facilitated patient mobilization, and the relatively little loss of correction using anterior and posterior implants are of considerable

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

et al. 2008

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“…Partial collapse can also occur because the ribs penetrate the endplate of the vertebrae above or below, already weakened after debridement of bone and disk sequestrectomy. The overall fusion rate of full-thickness iliac crest grafts [40], especially in patients with large defects [30,35], is better than that of rib; but in very large defects, such as those of tuberculosis, extensive iliac crest graft harvesting may provoke further problems, and fibular graft with posterior instrumentation should be considered [44].…”

Section: Techniquesmentioning

confidence: 99%

“…Pedicle screw instrumentation is usually combined in all cases in order to secure fixation [40]. In many series radical debridement and anterior insertion of a titanium cage, filled with autogenous bone graft, is also used together with posterior minimally invasive pedicle screw fixation in order to eliminate posterior soft tissue injury, to preserve blood supply, to reduce surgical time, blood loss and surgical complications [39].…”

Section: Interbody Cagesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

192

132

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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“…Controversies exist about the role of pretreatment biopsy [13,14]. We do not routinely perform this invasive maneuver.…”

Section: Epidemiology and Surgical Indicationsmentioning

confidence: 99%

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

et al. 2012

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Purpose Spondylodiscitis mainly affects the anterior part of the spine. In this paper, we retrospectively analyze our experience with the anterior stand-alone approach (ASAA) in the treatment of spinal infections. Methods Forty consecutive patients with severe spondylodiscitis underwent the ASAA during the acute infective phase. Treatment consisted of disease debridement, vertebral body reconstruction using titanium expandable prostheses and anterior fixation. Results There was neither mortality nor major morbidity. Successful arthrodesis was achieved in 39 out of 40 patients who remained disease free throughout the followup period. Six months after treatment, one patient experienced pseudarthrosis and required supplemented posterior spinal fixation for vertebral instability. However, adequate arthrodesis was eventually obtained even in this patient. Conclusions ASAA with spine reconstruction using synthetic materials during the acute infection phase was safe and effective. The infections were rapidly defeated, the patients were allowed to stand up early after the procedure and the length of hospital stay was significantly reduced.

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Single-Stage Treatment of Pyogenic Spinal Infection With Titanium Mesh Cages

Cited by 110 publications

References 27 publications

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

Surgical treatment of spondylodiscitis. An update

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

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