Abstract
The role of spinal implants in the presence of infection is critically discussed. In this study 20 patients with destructive vertebral osteomyelitis were surgically treated with one-stage posterior instrumentation and fusion and anterior debridement, decompression and anterior column reconstruction using an expandable titanium cage filled with morsellised autologous bone graft. The patients' records and radiographs were retrospectively analysed and follow-up clinical and radiographic data obtained. At a mean follow-up of 23 months (range 12–56 months) all cages were radiographically fused and all infections eradicated. There were no cases of cage dislocation, migration or subsidence. Local kyphosis was corrected from 9.2° (range −20° to 64°) by 9.4° to −0.2° (range −32° to 40°) postoperatively and lost 0.9° during follow-up . All five patients with preoperative neurological deficits improved to Frankel score D or E. Patient-perceived disability caused by back pain averaged 7.9 (range 0–22) in the Roland–Morris score at follow-up. In cases of vertebral osteomyelitis with severe anterior column destruction the use of titanium cages in combination with posterior instrumentation is effective and safe and offers a good alternative to structural bone grafts. Further follow-up is necessary to confirm these early results.
Similar content being viewed by others
References
Arnold P, Baek P, Bernardi R, Luck E, Larson S (1997) Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol 47:551–561
Carragee E (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880
Cobb J (1948) Outline for the study of scoliosis. In: Instructional course letters, vol 5. American Academy of Orthopaedic Surgeons, Ann Arbor
Eysel P, Hopf C, Vogel I, Rompe J (1997) Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Eur Spine J 6:152–157
Faraj A, Webb J (2000) Spinal instrumentation for primary pyogenic infection. Acta Orthop Belg 66:242–247
Frankel H, Hancock G, Hyslop G (1969) The value of postural reduction in the initial treatment of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–185
Hadjipavlou A, Mader J, Necessary J, Muffoletto A (2000) Hematogenous pyogenic infections and their surgical management. Spine 25:1668–1679
Hee H, Majd M, Holt R, Pienkowski D (2002) Better treatment of vertebral osteomyelitis using posterior stabilisation and titanium mesh cages. J Spinal Disord 15:149–156
Hodgson A, Stock F (1960) Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg Am 42:295–310
Kemp H, Jackson J, Jeremiah J (1973) Anterior fusion of the spine for infective lesions in adults. J Bone Joint Surg Br 55:715-734
Krodel A, Kruger A, Lohscheidt K, Pfahler M, Refior H (1999) Anterior debridement, fusion, and extrafocal stabilisation in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26
Lehovsky J (1999) Pyogenic vertebral osteomyelitis. Baillieres Best Pract Res Clin Rheumatol 13:59–75
Matsui H, Hirano N, Sakaguchi Y (1998) Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J 7:50–54
Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine 18:1890–1894
Przybylski G, Sharan A (2001) Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg 94:1–7
Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71:1314–1323
Rath S, Neff U, Schneider O, Richter H (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38:926–933
Sapico F (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27:9–13
Sundararaj G, Behera S, Ravi V, Venkatesh K, Cherian V, Lee V (2003) Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br 85:100–106
Wiesinger G, Nuhr M, Quittan M (1999) Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain. Spine 24:1099–1103
Yilmaz C, Selek H, Gurkan I, Erdemli B, Korkusuz Z (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81:1261–1267
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is dedicated to Professor Dr. Winfried Winkelmann, Head of the Department of Orthopedics, University Hospital of Münster, on the occasion of his 60th birthday, with best wishes and many thanks for all his support.
Rights and permissions
About this article
Cite this article
Liljenqvist, U., Lerner, T., Bullmann, V. et al. Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12, 606–612 (2003). https://doi.org/10.1007/s00586-003-0614-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-003-0614-z