Top

Published in:

01-09-2007 | Review

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

Authors: Wei-Hua Chen, Lei-Sheng Jiang, Li-Yang Dai

Published in: European Spine Journal | Issue 9/2007

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.

Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD (1995) Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord 8:278–283PubMed

Ani N, Keppler L, Biscup RS, Steffee AD (1991) Reduction of high-grade slips (grades III–V) with VSP instrumentation: report of a series of 41 cases. Spine 16:S302–S310PubMedCrossRef

Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence of materials for fixation implants on local infection: an experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surg Br 78:647–651PubMed

Asamoto S, Doi H, Kobayashi N, Endoh T, Sakagawa H, Iwanaga Y, Ida M, Jinbo H (2005) Spondylodiscitis: diagnosis and treatment. Surg Neurol 64:103–108PubMedCrossRef

Aydinli U, Karaeminogullari O, Tiskaya K (1999) Postoperative deep wound infection in instrumented spinal surgery. Acta Orthop Belg 65:182–187PubMed

Bateman JL, Pevzner MM (1995) Spinal osteomyelitis: a review of 10 years’ experience. Orthopedics 18:561–565PubMed

Belzunegui J, Intxausti JJ, De Dios JR, Del Val N, Rodriguez Valverde V, Gonzalez C, Queiro R, Figueroa M (2000) Haematogenous vertebral osteomyelitis in the elderly. Clin Rheumatol 19:344–347PubMedCrossRef

Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33:527–532PubMedCrossRef

Bhat AL, Lowery GL, Sei A (1999) The use of titanium surgical mesh-bone graft composite in the anterior thoracic or lumbar spine after complete or partial corpectomy. Eur Spine J 8:304–309PubMedCrossRef

10.

Broner FA, Garland DE, Zigler JE (1996) Spinal infections in the immunocompromised host. Orthop Clin North Am 27:37–46PubMed

11.

Cahill DW, Love LC, Rechtine GR (1991) Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg 74:878–886PubMed

12.

Carragee EJ (1997) Instrumentation of the infected and unstable spine: a review of 17 cases from the thoracic and lumbar spine with pyogenic infections. J Spinal Disord 10:317–324PubMedCrossRef

13.

Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880PubMedCrossRef

14.

Chelsom J, Solberg CO (1998) Vertebral osteomyelitis at a Norwegian university hospital 1987–97: clinical features, laboratory findings and outcome. Scand J Infect Dis 30:147–151PubMedCrossRef

15.

Christodoulou AG, Givissis P, Karataglis D, Symeonidis PD, Pournaras J (2006) Treatment of tuberculous spondylitis with anterior stabilization and titanium cage. Clin Orthop 444:60–65PubMed

16.

Dietze DD Jr, Fessler RG, Jacob RP (1997) Primary reconstruction for spinal infections. J Neurosurg 86:981–989PubMed

17.

Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine 29:326–332PubMedCrossRef

18.

Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA (1983) Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am 65:19–29PubMed

19.

Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14:284–291PubMed

20.

Fang D, Cheung KM, Dos Remedios ID, Lee YK, Leong JC (1994) Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion. J Spinal Disord 7:173–180PubMedCrossRef

21.

Faraj AA, Webb JK (2000) Spinal instrumentation for primary pyogenic infection report of 31 patients. Acta Orthop Belg 66:242–247PubMed

22.

Fayazi AH, Ludwig SC, Dabbah M, Bryan Butler R, Gelb DE (2004) Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis. Spine J 4:388–395PubMedCrossRef

23.

Fountain SS (1979) A single-stage combined surgical approach for vertebral resections. J Bone Joint Surg Am 61:1011–1017PubMed

24.

Fukuoka M, Aita K, Aoki Y, Hayashi S, Satoh T, Hotokebuchi T, Nagasawa K (2002) Pyogenic vertebral osteomyelitis caused by Prevotella intermedia. J Infect Chemother 8:182–184PubMedCrossRef

25.

Fukuta S, Miyamoto K, Masuda T, Hosoe H, Kodama H, Nishimoto H, Sakaeda H, Shimizu K (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E302–E308PubMedCrossRef

26.

Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F, Mirabile L, Barbanti Brodano G, Furno A, Gasbarrini A, Boriani S (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66PubMed

27.

Glassman SD, Dimar JR, Puno RM, Johnson JR (1996) Salvage of instrumental lumbar fusions complicated by surgical wound infection. Spine 21:2163–2169PubMedCrossRef

28.

Graziano GP, Sidhu KS (1993) Salvage reconstruction in acute and late sequelae from pyogenic thoracolumbar infection. J Spinal Disord 6:199–207PubMed

29.

Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine 30:38–43PubMedCrossRef

30.

Hadjipavlou AG, Katonis PK, Gaitanis IN, Muffoletto AJ, Tzermiadianos MN, Crow W (2004) Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Eur Spine J 13:707–713PubMedCrossRef

31.

Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25:1668–1679PubMedCrossRef

32.

Hee HT, Majd ME, Holt RT, Pienkowski D (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149–156PubMed

33.

Hodgson AR, Stock FE (1956) Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44:266–275PubMedCrossRef

34.

Holte DC, Winter RB, Lonstein JE, Denis F (1995) Excision of hemivertebrae and wedge resection in the treatment of congenital scoliosis. J Bone Joint Surg Am 77:159–171PubMed

35.

Klockner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine 28:1036–1042PubMedCrossRef

36.

Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) One-stage combined surgery with mesh cages for treatment of septic spondylitis. Clin Orthop 444:51–59PubMed

37.

Korovessis P, Sidiropoulos P, Piperos G, Karagiannis A (1993) Spinal epidural abscess complicated closed vertebral fracture: a case report and review of literature. Spine 18:671–674PubMedCrossRef

38.

Kostuik JP (1983) Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results. Spine 8:512–531PubMedCrossRef

39.

Krish G, Beaver W, Sarubbi F, Verghese A (1989) Corynebacterium xerosis as a cause of vertebral osteomyelitis. J Clin Microbiol 27:2869–2870PubMed

40.

Kumar A, Sandoe J, Kumar N (2005) Three cases of vertebral osteomyelitis caused by Streptococcus dysgalactiae subsp. equisimilis. J Med Microbiol 54:1103–1105PubMedCrossRef

41.

Kuo CH, Wang ST, Yu WK, Chang MC, Liu CL, Chen TH (2004) Postoperative spinal deep wound infection: a six-year review of 3230 selective procedures. J Chin Med Assoc 67:398–402PubMed

42.

Lee MC, Wang MY, Fessler RG, Liauw J, Kim DH (2004) Instrumentation in patients with spinal infection. Neurosurg Focus 17:E7PubMed

43.

Liebergall M, Chaimsky G, Lowe J, Robin GC, Floman Y (1991) Pyogenic vertebral osteomyelitis with paralysis: prognosis and treatment. Clin Orthop 142–150

44.

Liljenqvist U, Lerner T, Bullmann V, Hackenberg L, Halm H, Winkelmann W (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:606–612PubMedCrossRef

45.

Macdonald RL, Fehlings MG, Tator CH, Lozano A, Fleming JR, Gentili F, Bernstein M, Wallace MC, Tasker RR (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:990–997PubMedCrossRef

46.

Malawski SK, Lukawski S (1991) Pyogenic infection of the spine. Clin Orthop 58–66

47.

Mann S, Schutze M, Sola S, Piek J (2004) Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus 17:E3PubMed

48.

Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR (1992) Postoperative posterior spinal wound infections. Clin Orthop 99–108

49.

Masuda T, Miyamoto K, Hosoe H, Sakaeda H, Tanaka M, Shimizu K (2006) Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases. Arch Orthop Trauma Surg 126:339–345PubMedCrossRef

50.

Matter P, Burch HB (1990) Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system. Arch Orthop Trauma Surg 109:311–313PubMedCrossRef

51.

McGuire RA, Eismont FJ (1994) The fate of autogenous bone graft in surgically treated pyogenic vertebral osteomyelitis. J Spinal Disord 7:206–215PubMedCrossRef

52.

McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34:1342–1350PubMedCrossRef

53.

Molinari RW, Bridwell KH, Klepps SJ, Baldus C (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24:967–972PubMedCrossRef

54.

Muckley T, Schutz T, Schmidt MH, Potulski M, Buhren V, Beisse R (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine 29:E227–E233PubMedCrossRef

55.

Nakase H, Tamaki R, Matsuda R, Tei R, Park YS, Sakaki T (2006) Delayed reconstruction by titanium mesh-bone graft composite in pyogenic spinal infection: a long-term follow-up study. J Spinal Disord Tech 19:48–54PubMedCrossRef

56.

Nather A, David V, Hee HT, Thambiah J (2005) Pyogenic vertebral osteomyelitis: a review of 14 cases. J Orthop Surg 13:240–244

57.

Ogden AT, Kaiser MG (2004) Single-stage debridement and instrumentation for pyogenic spinal infections. Neurosurg Focus 17:E5PubMed

58.

Osenbach RK, Hitchon PW, Menezes AH (1990) Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol 33:266–275PubMedCrossRef

59.

Ozuna RM, Delamarter RB (1996) Pyogenic vertebral osteomyelitis and postsurgical disc space infections. Orthop Clin North Am 27:87–94PubMed

60.

Perren SM (1991) The concept of biological plating using the limited contact-dynamic compression plate (LC-DCP): scientific background, design and application. Injury 22(Suppl 1):1–41PubMed

61.

Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24:558–561PubMed

62.

Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH (2000) Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13:42–45PubMedCrossRef

63.

Pihlajamaki H, Myllynen P, Bostman O (1997) Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg Br 79:183–189PubMedCrossRef

64.

Priest DH, Peacock JE Jr (2005) Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J 98:854–862PubMedCrossRef

65.

Przybylski GJ, Sharan AD (2001) Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg 94:1–7PubMed

66.

Rath SA, Neff U, Schneider O, Richter HP (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38:926–933PubMedCrossRef

67.

Redfern RM, Miles J, Banks AJ, Dervin E (1988) Stabilisation of the infected spine. J Neurol Neurosurg Psychiatry 51:803–807PubMedCrossRef

68.

Rezai AR, Woo HH, Errico TJ, Cooper PR (1999) Contemporary management of spinal osteomyelitis. Neurosurgery 44:1018–1026PubMedCrossRef

69.

Robertson PA, Rawlinson HJ, Hadlow AT (2004) Radiologic stability of titanium mesh cages for anterior spinal reconstruction following thoracolumbar corpectomy. J Spinal Disord Tech 17:44–52PubMedCrossRef

70.

Safran O, Rand N, Kaplan L, Sagiv S, Floman Y (1998) Sequential or simultaneous, same-day anterior decompression and posterior stabilization in the management of vertebral osteomyelitis of the lumbar spine. Spine 23:1885–1890PubMedCrossRef

71.

Schuster JM, Avellino AM, Mann FA, Girouard AA, Grady MS, Newell DW, Winn HR, Chapman JR, Mirza SK (2000) Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 93:8–14PubMed

72.

Shad A, Shariff S, Fairbank J, Byren I, Teddy PJ, Cadoux-Hudson TA (2003) Internal fixation for osteomyelitis of cervical spine: the issue of persistence of culture positive infection around the implants. Acta Neurochir 145:957– 960CrossRef

73.

Solis-Garcia del Pozo J, Martinez-Alfaro E, Abad L, Solera J (2000) Vertebral osteomyelitis caused by Streptococcus agalactiae. J Infect 41:84–90CrossRef

74.

Stone JL, Cybulski GR, Rodriguez J, Gryfinski ME, Kant R (1989) Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine. J Neurosurg 70:879–883PubMedCrossRef

75.

Tyrrell PN, Cassar-Pullicino VN, McCall IW (1999) Spinal infection. Eur Radiol 9:1066–1077PubMedCrossRef

76.

van Dijk M, Smit TH, Burger EH, Wuisman PI (2002) Bioabsorbable poly-L-lactic acid cages for lumbar interbody fusion: three-year follow-up radiographic, histologic, and histomorphometric analysis in goats. Spine 27:2706–2714PubMedCrossRef

77.

Wisneski RJ (1991) Infectious disease of the spine. Diagnostic and treatment considerations. Orthop Clin North Am 22:491–501PubMed

78.

Yuan HA, Garfin SR, Dickman CA, Mardjetko SM (1994) A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spinal fusions. Spine 19:2279S–2296SPubMedCrossRef

Title: Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation
Authors: Wei-Hua Chen
Lei-Sheng Jiang
Li-Yang Dai
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 9/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-006-0251-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2007

Comments on “Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation” (W. -H. Chen et al.)

Comment on “Comparison between constrained and non-constrained Cobb techniques for the assessment of thoracic kyphosis and lumbar lordosis” (J.-M. Mac-Thiong et al.)

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves

Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis

Another option to treat Kümmell’s disease with cord compression