One-Stage Biopsy, Debridement, Reconstruction, and Stabilization of Pyogenic Vertebral Osteomyelitis
02 May 2013
21 January 2014
03 March 2014 (eFirst)
Study Design Retrospective cohort study.
Objective To evaluate whether the proposed one-stage biopsy, culture, debridement, and reconstruction with stabilization strategy is a viable option for pyogenic vertebral osteomyelitis (PVO). PVO is increasing in frequency globally, particularly in immunologically compromised individuals. Typically, biopsy and culture sensitivity followed by staged surgery and long-term antibiotic therapy is the mainstay of therapy.
Methods This is a study of a group of 32 consecutive cases of PVO (spondylodiskitis) treated in our institution from 2010 to 2012. All cases had one-stage biopsy, culture sensitivity, debridement, reconstruction with iliac bone graft, and stabilization with titanium implants. The mean age in this series was 51 years, and the male-to-female ratio was 2.2:1. Approximately 50% of the patients had impaired immunity status. The commonest organism isolated was Pseudomonas aeruginosa. Culture-specific antibiotics were given for a minimum of 6 weeks to all patients. The follow-up period ranged from 6 months to a maximum of 2 years. All patients were assessed for wound healing, recurrence of infection, deformity progression, pain, and healing by radiologic and biochemical parameters. No generic or disease-specific outcome tools were used for this study.
Results All patients had good wound healing, although there was one case of superficial infection that was resolved with debridement. There were two implant failures with pseudarthrosis and one localized kyphosis in this series.
Conclusions The one-stage technique of biopsy, debridement, bone grafting, and stabilization can be recommended for most cases of PVO.
- 1 Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 1997; 79 (6) 874-880
- 2 Boos N. Infections of the spine. In: Boos N, Aebi M, , eds. Spinal Disorders: Fundamentals of Diagnosis and Treatment. Heidelberg, Germany: Springer; 2008: 1021-1039
- 3 Butler JS, Shelly MJ, Timlin M, Powderly WG, O'Byrne JM. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 2006; 31 (23) 2695-2700
- 4 Calderone RR, Larsen JM. Overview and classification of spinal infections. Orthop Clin North Am 1996; 27 (1) 1-8
- 5 Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 2000; 25 (13) 1668-1679
- 6 Tay BK, Deckey J, Hu SS. Spinal infections. J Am Acad Orthop Surg 2002; 10 (3) 188-197
- 7 Carragee E, Iezza A. Does Acute placement of instrumentation in the treatment of vertebral osteomyelitis predispose to recurrent infection: long-term follow-up in immune-suppressed patients. Spine (Phila Pa 1976) 2008; 33 (19) 2089-2093
- 8 Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 2010; 19 (4) 575-582
- 9 Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR. Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 2004; 29 (3) 326-332 , discussion 332
- 10 Eysel P, Hopf C, Vogel I, Rompe JD. Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study. Eur Spine J 1997; 6 (3) 152-157
- 11 Ruf M, Stoltze D, Merk HR, Ames M, Harms J. Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages. Spine (Phila Pa 1976) 2007; 32 (9) E275-E280
- 12 Chen WH, Jiang LS, Dai LY. Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 2007; 16 (9) 1307-1316
- 13 Kuklo TR, Potter BK, Bell RS, Moquin RR, Rosner MK. Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 2006; 19 (5) 376-382
- 14 Liljenqvist U, Lerner T, Bullmann V, Hackenberg L, Halm H, Winkelmann W. Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 2003; 12 (6) 606-612
- 15 Schuster JM, Avellino AM, Mann FA , et al. Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 2000; 93 (1, Suppl) 8-14
- 16 Lee MC, Wang MY, Fessler RG, Liauw J, Kim DH. Instrumentation in patients with spinal infection. Neurosurg Focus 2004; 17 (6) E7
- 17 Jeanneret B, Magerl F. Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation. J Spinal Disord 1994; 7 (3) 185-205
- 18 Halpern EM, Bacon SA, Kitagawa T, Lewis SJ. Posterior transdiscal three-column shortening in the surgical treatment of vertebral discitis/osteomyelitis with collapse. Spine (Phila Pa 1976) 2010; 35 (13) 1316-1322
- 19 Sundararaj GD, Babu N, Amritanand R , et al. Treatment of haematogenous pyogenic vertebral osteomyelitis by single-stage anterior debridement, grafting of the defect and posterior instrumentation. J Bone Joint Surg Br 2007; 89 (9) 1201-1205
- 20 Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am 2006; 88 (4) 869-882