Two-stage Management for Vertebral Osteomyelitis and Epidural Abscess: Technical Note

Abstract

Without denying the efficacy of the single-stage surgery, two-stage management can be a reasonable alternative for carefully selected patients who have spinal infection.

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

“…After a surgical debridement and subsequent 4 weeks of intravenous antibiotic therapy, the patients underwent autogenous bone grafting and anterior plating. Since then, several series have been presented with patients undergoing anterior corpectomy and plate fixation [10,15,24,30,37,38,44,48,51], but the number of patients enrolled in these studies was relatively small and most of them were cervical cases.…”

“…There has been great concern of placing instrumentation in the presence of infection because of the potentiality of infection recurrence after surgery [31,37,48]. In the current study, the efficacy and safety of anterior instrumentation was prospectively evaluated, in patients who underwent simultaneous anterior debridement and autogenous bone grafting for pyogenic vertebral osteomyelitis of thoracic and lumbar spine, for at least 3 years after surgery.…”

Complex Wounds in Patients Receiving Hemodialysis

“…If a patient shows relapsed wound infection without necrosis and foreign bodies remaining in the wound, cleansing the wound using continuous irrigation employing suction and irrigation system is recommended. This was also adapted for the treatment of osteomyelitis (Figure 15) 29) . It is concluded that when a risk of recurring an infection remains after primary debridement, two-stage management, involving late second stage surgery included secondary debridement and stable reconstruction, should be considered.…”

Single-stage anterior debridement and fusion with autografting and internal fixation for pyogenic lumbar spondylodiscitis

“…Some literature reports using a posterior debridement technique, bone grafting, and pedicle screws to treat pyogenic spondylodiscitis [12,18,22]. Other studies report anterior debridement and bone fusion using bone grafting or titanium mesh cages, and a single-or two-staged posterior pedicle screw system in treatment of this condition [21,24]. Still others report anterior debridement, intervertebral bone fusion using bone grafting or titanium mesh cages, and fixation of three spinal segments with an anterior plate as a safe and effective procedure for destructive vertebral osteomyelitis in the spine [8].…”