Abstract
Introduction
Between 1997 and 2006, we treated 11 patients with tuberculotic spondylitis and 19 with pyogenic spondylitis using a two-staged operation (posterior spinal instrumentation, followed by anterior debridement and fusion).
Method
We compared changes in inflammatory reactions, postoperative complications, organisms obtained during anterior debridement, neurological status, bone union, and suppression of the infection between the patients with tuberculotic and pyogenic spondylitis.
Patients
All patients in both groups achieved bone union and suppression of the infected sites. Decreases in C-reactive protein and erythrocyte sedimentation rate were significantly slower in the patients with tuberculotic spondylitis. Positive bacterial cultures at the second anterior debridement were obtained from 26% of patients with pyogenic spondylitis and 55% of patients with tuberculotic spondylitis. Frankel types improved in 57% of patients, but there were no differences in neurological improvement. The efficacy of the two-staged operation did not differ between the patients with pyogenic and tuberculotic spondylitis.
Results
Although the baselines were different, there were no significant differences in relative operating parameters, neurological improvement, or postoperative complications between the two groups. At the final follow-up, all patients finally achieved suppression of spinal infection and solid bone fusion in both groups, although the decline in inflammatory parameters was slower in the T group than in the P group.
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References
Buchelt M, Lack W, Kutschera HP, Katterschafka T, Kiss H, Schneider B, Kotz R (1993) Comparison of tuberculous and pyogenic spondylitis: an analysis of 122 cases. Clin Orthop Relat Res 296:192–199
Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, García de las Heras J, Pachón J (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56:709–715
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 29:326–332
Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14:284–291
Faraj AA, Webb JK (2000) Spinal instrumentation for primary pyogenic infection report of 31 patients. Acta Orthop Belg 66:242–247
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–E308
Güven O, Kumano K, Yalçin S, Karahan M, Tsuji S (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043
Hirakawa A, Miyamoto K, Ohno Y, Hioki A, Ogawa H, Nishimoto H, Yokoi T, Hosoe H, Shimizu K (2008) Two-stage (posterior and anterior) surgical treatment of spinal osteomyelitis due to atypical mycobacteria and associated thoracolumbar kyphoscoliosis in a nonimmunocompromised patient. Spine 33:E221–E224
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 28:1036–1042
Krödel A, Krüger A, Lohscheidt K, Pfahler M, Refior HJ (1999) Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26
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 126:339–345
Matsui H, Hirano N, Sakaguchi Y (1998) Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J 7:50–54
Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916
Nakase H, Matsuda R, Tamaki R, Tei R, Park YS, Sakaki T (2006) Two-stage management for vertebral osteomyelitis and epidural abscess: technical note. Neurosurgery 58:E1219
Rezai AR, Lee M, Cooper PR, Errico TJ, Koslow M (1995) Modern management of spinal tuberculosis. Neurosurgery 36:87–97
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 23:1885–1890
Tanaka M, Nakahara S, Takeuchi K (2003) Single-stage autogenous bone graft and posterior instrumentation in infectious spondylitis. Spine J 3:149S–150S (abstract)
Yamada T, Mizuno J, Matsushita Y, Nakagawa H (2001) Two-staged operation for thoracolumbar osteomyelitis following methicillin-resistant Staphylococcus aureus infection of a craniectomy wound—case report. Neurol Med Chir 41:325–329
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Masuda, T., Miyamoto, K., Hosoe, H. et al. Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis. Arch Orthop Trauma Surg 131, 765–772 (2011). https://doi.org/10.1007/s00402-010-1209-x
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DOI: https://doi.org/10.1007/s00402-010-1209-x