Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

Abstract

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.

Failure modes in conservative and surgical management of infectious spondylodiscitis

“…We had no cases in which revision was done because of persistent infection due to the instrumentation used. This is in accordance with the consensus among other authors that the use of instrumentation in an infected area of the spine is safe and does not lead to persistence or recurrence of infection [3,16,17]. Seven patients with affected cervical spine were subjected to anterior debridement and stabilization.…”

“…It is also obvious that the failure of conservative measures, compression of neural elements, mechanical derangement (instability, malalignment, severe bone destruction), and intractable pain demands surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment and correction of instability [7,8,18]. However, surgeons still discuss staging, surgical access, and usage of instrumentation or cages [3,14,15,20]. Furthermore, minimally invasive and endoscopic surgeries are being promoted [9,11].…”

SAPHO Syndrome: Imaging Findings of Vertebral Involvement

“…This is in contrast to osteomyelitis and discitis, in which males are affected twice as often as females and the lumbar spine is most commonly affected. 21 MR imaging of the spine and sacroiliac joints has played a key role in patients with spondyloarthropathies and has led to improved understanding of the course of the disease and to an earlier diagnosis. 20 We suggest an imaging protocol consisting of at least a sagittal T1-weighted turbo spin-echo sequence, sagittal fat-saturated T2-weighted turbo spin-echo sequence or STIR sequence with high resolution, and a sagittal fat-saturated gadolinium-enhanced T1-weighted sequence for evaluation of patients with suspected SAPHO syndrome, spondyloarthropathy, or osteomyelitis/discitis.…”

Surgical treatment of spondylodiscitis. An update

“…Surgical evacuation of an anterior abscess is indicated whenever it is larger than 2.5 cm, and should concomitant vertebral body destruction exist bone debridement with subsequent reconstruction must be carried out. Unsuccessful medical treatment including negative biopsy or stubborn pain may also be an indication for surgery [11], provided some potential objective cause exists.…”