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Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases

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Abstract

Introduction: The treatment of methicillin-resistant Staphylococcus aureus (MRSA) spondylodiscitis is reported to be far more difficult than that of non-MRSA spondylodiscitis. At present, there seems to be no standard protocol for the treatment of MRSA spondylodiscitis cases in which conservative management has failed. Materials and methods: Between 1998 and 2001, five patients (aged 48–73 years; average: 63.8 years; SD: 9.9) with MRSA spondylodiscitis were treated surgically after conservative treatment had failed. Posterior spinal instrumentation was performed for all five patients, three of whom also underwent anterior debridement and bone graft. All the patients had neurological deficits and severe pain. To assess the invasiveness of the operation, we evaluated operating time, blood loss, and complications. Pain (verbal rating scale; VRS), neurological status (Frankel type), activities of daily living (ADL) (the Barthel index), WBC, CRP, and ESR in the preoperative, postoperative and final follow-up periods were used to evaluate the surgical outcomes. Results: Although we encountered several postoperative complications including deep wound infections, at the final follow-up visit, the neurological deficits, activities of daily living, Barthel index, and VRS had improved in all the patients. Changes in WBC, CRP, and ESR revealed suppression of infection in all patients. Conclusion: Surgical treatment for MRSA spondylodiscitis with posterior spinal instrumentation provided patients with satisfactory final outcomes.

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Acknowledgements

The authors would like to thank Dr. M. Hibino (Yamauchi Hospital, Gifu, Japan), Dr. T. Yamamoto (Department of Orthopaedic Surgery, Gifu University School of Medicine), Dr. A. Shimoji, (Komoro Kousei Hospital, Nagano, Japan) Dr. K. Masuda, Dr. T. Dohjima (Gihoku Kousei Hospital, Gifu, Japan), Dr. H. Nishimoto (Gifu Central Hospital, Gifu, Japan), and Dr. H. Kodama (Nagara Orthopaedic Clinic, Gifu, Japan) for their contributions to this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, Gifu-pre., 501–1194, Japan

    Takahiro Masuda, Kei Miyamoto, Hideo Hosoe & Katsuji Shimizu

  2. Department of Orthopaedic Surgery, Gifu Red Cross Hospital, 3–36 Iwakura-Cho, Gifu City, Gifu-pre., 502–0844, Japan

    Hirofumi Sakaeda

  3. Tanaka Orthopaedic Hospital, 267-6 Okagakimachinoma, Onga Gun, Fukuoka-pre., 811–4233, Japan

    Mizuo Tanaka

Authors
  1. Takahiro Masuda
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  2. Kei Miyamoto
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  3. Hideo Hosoe
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  4. Hirofumi Sakaeda
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  5. Mizuo Tanaka
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  6. Katsuji Shimizu
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Correspondence to Katsuji Shimizu.

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Masuda, T., Miyamoto, K., Hosoe, H. et al. 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, 339–345 (2006). https://doi.org/10.1007/s00402-006-0114-9

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  • DOI: https://doi.org/10.1007/s00402-006-0114-9

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