Two-Staged Operation for Thoracolumbar Osteomyelitis Following Methicillin-Resistant Staphylococcus Aureus Infection of a Craniectomy Wound. Case Report.

Abstract

A previously healthy 53-year-old woman developed pyogenic vertebral osteomyelitis (PVO) manifesting as progressive lumbago following wound infection of a decompressive craniectomy performed for brain contusion caused by a traffic accident. Magnetic resonance imaging disclosed vertebral osteomyelitis at T-12 and L-1 with paravertebral abscess. Anterior debridement and fusion using autografts were performed at the first operation. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the abscess specimen. Antibiotic therapy resolved the infection. Pedicle screw fixation was performed at the second operation. The patient became free from back pain and no recurrence of infection was seen. The diagnosis of PVO is frequently observed or delayed because of the nonspecific symptomatic presentation in the early stage. Coexistent infection or trauma makes early diagnosis more difficult. Indications and timing of instrumentation for the spinal column infected with MRSA is difficult. Twostaged operation with anterior debridement and posterior instrumentation after eradication of the infection is a safe and effective procedure for MRSA vertebral osteomyelitis.

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

“…A method that is in contrast to ours was presented in the literature by Yamada et al, 14 who reported successful clinical experience with methicillin-resistant S. aureus spondylitis by a two-stage operation. They performed anterior debridement at the first stage, and then applied posterior instrumentation after giving postoperative chemotherapy for 4 weeks and confirming that the infection had been suppressed.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, for those whose infections are resistant to antibiotic chemotherapy and who have major bone destruction, neurologic impairment, recurrence of infection, and severe pain, surgical treatment by anterior debridement and bone grafting is indicated. [1][2][3]8,9,13 Generally, debridement of the infected site and autogenous bone graft are the surgical procedures of first choice.…”

“…3,7,8,9,11 Recently, some authors have reported the use of posterior spinal instrumentation in pyogenic or tuberculotic spondylitis in an attempt to gain stability and enable early ambulation. 8,9,11,14,15 However, to achieve anterior debridement and place posterior instrumentation, combined anterior and posterior procedures are required. In a series of 10 consecutive patients who had been managed by one-stage surgery with anterior debridement, bone grafting, and posterior spinal instrumentation, Safran et al 11 reported that they encountered no perioperative complications from the invasiveness of one-stage surgery.…”

“…2,3,9,16 Another aspect of pyogenic and tuberculotic spondylitis is that because the spine manifests destructive changes in the advanced stages of these diseases, patients have severe back pain because of instability of the infected site. 3,11,12,14 Therefore, once surgical treatment is planned, the strategy should be aimed at immediate relief of the severe pain and encouraging early ambulation.…”

Perfil epidemiológico e avaliação da resposta ao tratamento cirúrgico nos pacientes com espondilodiscite atendidos no serviço de cirurgia da coluna do Hospital Getúlio Vargas em Recife/PE

“…Quando se realiza primeiro a cirurgia por VA para desbridamento e enxerto o paciente é submetido a um maior tempo cirúrgico e maior perda de sangue, apesar de terem sido descritos bons resultados com essa estratégia 11,15,16 . Nas situações em que a primeira cirurgia é a VP, menos agressiva e com tempo cirúrgico menor, obtém-se estabilização e redução importante da intensidade das dores, promovendo diminuição e algumas vezes até resolução da infecção anterior.…”