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Reconstruction of large defects in vertebral osteomyelitis with expandable titanium cages

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Abstract

The purpose of this study was to investigate the outcome of expandable titanium cage implantation in large defects caused by acute vertebral osteomyelitis. Twenty-five patients with acute single or multilevel spondylodiscitis were treated after radical débridement and posterior instrumentation with an anterior expandable titanium cage and bone grafting. Clinical, laboratory and radiological follow-up continued for 36 months. Within the postoperative course there was no recurrence of spinal infection. The final radiological examination showed successful fusion in all cases without implant loosening or failure. At the final follow-up after 36 months the Oswestry Disability Index was 23 ± 14 and the pain visual analogue scale 2.1 ± 1.7. This study reveals healing and improved function after expandable titanium cage implantation in all patients. Prerequisites for optimal healing include radical débridement, provision of stability for weight-bearing, adequate bone grafting and correction of deformity using rigid implants.

Résumé

Le but de cette étude est d’analyser le devenir des cages titane expansibles implantées dans le cas de perte de substances osseuses aiguës vertébrales après ostéomyélite. Matériel et méthode: 25 patients présentant une spondylodiscite à un ou plusieurs niveaux ont été traités. Après mise à plat, instrumentation postérieure, mise en place d’une cage antérieure expansible et greffe, les patients ont été suivis pendant 36 mois sur le plan clinique, biologique et radiologique. Résultats: il n’y a pas eu de récidive de l’infection. Le résultat radiologique a montré une bonne fusion dans tous les cas sans descellement ou échec de l’implant. Au suivi final de 36 mois, l’index d’Oswestry est de 23 ± 14 et l’échelle douloureuse visuelle analogique est de 2.1 ± 1.7. En conclusion, cette étude permet de montrer que ces cages autorisent une cicatrisation et une amélioration de la fonction chez ces patients. Néanmoins, il est nécessaire pour obtenir ce résultat de réaliser une mise à plat, d’adapter la remise en charge, de faire une greffe également adaptée et de corriger les déformations par une instrumentation rigide.

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Authors and Affiliations

  1. Charité-Campus Benjamin Franklin, Center for Trauma and Reconstructive Surgery, Spine Unit, Hindenburgdamm 30, 12200, Berlin, Germany

    Yohan Robinson, Sven Kevin Tschoeke, Ralph Kayser & Christoph E. Heyde

  2. Department for Orthopaedic Surgery, Spinal Surgery and Paraplegiology, Central Clinic Bad Berka, Bad Berka, Germany

    Heinrich Boehm

Authors
  1. Yohan Robinson
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  2. Sven Kevin Tschoeke
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  3. Ralph Kayser
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  4. Heinrich Boehm
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  5. Christoph E. Heyde
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Correspondence to Christoph E. Heyde.

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Robinson, Y., Tschoeke, S.K., Kayser, R. et al. Reconstruction of large defects in vertebral osteomyelitis with expandable titanium cages. International Orthopaedics (SICOT) 33, 745–749 (2009). https://doi.org/10.1007/s00264-008-0567-2

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  • DOI: https://doi.org/10.1007/s00264-008-0567-2

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