Two-Stage (Posterior and Anterior) Surgical Treatment Using Posterior Spinal Instrumentation for Pyogenic and Tuberculotic Spondylitis

Fukuta, Shoji; Miyamoto, Kei; Masuda, Takahiro; Hosoe, Hideo; Kodama, Hirotaka; Nishimoto, Hirofumi; Sakaeda, Hirofumi; Shimizu, Katsuji

doi:10.1097/01.brs.0000083318.40123.5e

Cited by 111 publications

(73 citation statements)

References 18 publications

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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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Section: Discussionmentioning

confidence: 99%

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

2008

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“…1) [17,21,22,25,28,32,36,42,44,49,55,56,65,66,71]. The majority of operations were performed in a fashion of combined approach, which account 66% in 312 procedures.…”

Section: Anterior or Posterior Approachmentioning

confidence: 99%

“…An exception is Fountain's series, in which posterior instrumentation was used in the management of infectious vertebral lesion [23]. Even the importance of immobilization for the suppression of infection have been emphasized by several researchers [10,25], but it was not until the 1990s of the last century, internal fixation started gaining some acceptance in reconstructive surgery performed in the setting of active infection, and more and more surgeons reported their series of surgical treatment of spinal infections with excellent results [12, 13, 15-17, 21, 22, 25, 28, 32, 36, 44, 47, 49, 55-57, 65, 66]. Surgical intervention with instrumentation can relieve pain, improve sagittal balance and neurologic function, and finally result in early ambulation.…”

Section: Introductionmentioning

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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“…The advocates for spinal instrumentation argued that stabilization of the spine is very important for the suppression and eventual elimination of infections [13,14]. Increasing evidence has also showed that instrumentation in the presence of active infection is well tolerated while spinal stability is maintained effectively with sufficient restoration of sagittal alignment of the spine and relatively shorter duration of bed rest [3,[14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

et al. 2013

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Objective This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. Methods Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85 %) of all 20 animals. The positive rate for bacteria presence was 45 % by culture and 80 % by pyrosequencing method. Results Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culturepositive animals. Conclusion Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the ''culprit'' for the persistence or recurrence of infection.

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Two-Stage (Posterior and Anterior) Surgical Treatment Using Posterior Spinal Instrumentation for Pyogenic and Tuberculotic Spondylitis

Abstract: This two-stage surgical treatment for pyogenic or tuberculotic spondylitis provided satisfactory results and can also be used in patients who are in poor general condition.

Cited by 111 publications

References 18 publications

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

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

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

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