Skip to main content
SpringerLink
Log in

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction.

Methods

Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8–56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria).

Results

Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1–4) days in ICU and were able to walk unaided 1.6 (1–2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1–18) degrees, with loss of correction of 4 (0–19) degrees at final follow-up.

Conclusions

Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Acosta FL Jr, Chin CT, Quinones-Hinojosa A, Ames CP, Weinstein PR, Chou D (2004) Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 17:2

    Article  Google Scholar 

  2. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine 31:2695–2700

    Article  PubMed  Google Scholar 

  3. Cramer J, Haase N, Behre I, Ostermann PAW (2003) Spondylitis und spondylodiszitis. Trauma Berufskrankheit 5:336–341

    Article  Google Scholar 

  4. Frangen TM, Kälicke T, Gottwald M, Andereya S, Andress HJ, Russe OJ, Muller EJ, Muhr G, Schinkel C (2006) Die operative Therapie der Spondylodiszitis. Eine Analyse von 78 Patienten. Der Unfallchirurg 109:743–753

    Article  PubMed  CAS  Google Scholar 

  5. Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect 4:387–391

    Article  Google Scholar 

  6. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Non tuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral centre. Spine 31:2695–2700

    Article  PubMed  Google Scholar 

  7. Nolla JM, Ariza J, Gomez-Vaquero C, Fiter J, Bermejo J, Valverde J, Escofet DR, Gudiol F (2002) Spontaneous pyogenic vertebral osteomyelitis in non-drug-users. Semin Arthritis Rheum 31:271–278

    Article  PubMed  Google Scholar 

  8. Linhardt O, Matussek J, Refior HJ, Krödel A (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31:113–119

    Article  PubMed  CAS  Google Scholar 

  9. Woertgen C, Rothoerl RD, Englert C, Neumann C (2006) Pyogenic spinal infections and outcome according to the 36-Item Short Form Health Survey. J Neurosurg Spine 4:441–446

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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 4:388–395

    Article  PubMed  Google Scholar 

  12. 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 9:53–66

    PubMed  CAS  Google Scholar 

  13. 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 Relat Res 444:51–59

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. 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 93:8–14

    PubMed  CAS  Google Scholar 

  16. 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 44:266–275

    Article  PubMed  CAS  Google Scholar 

  17. Heyde CE, Boehm H, El Saghir H, Tschoke SK, Kayser R (2006) Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up. Eur Spine J 15:1380–1387

    Article  PubMed  Google Scholar 

  18. Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16:1307–1316

    Article  PubMed  Google Scholar 

  19. Waring WP 3rd, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A, Jones L, Kirshblum S, Marino R, Mulcahey MJ, Reeves R, Scelza WM, Schmidt-Read M, Stein A (2010) 2009 review and revisions of the international standards for the neurological classification of spinal cord injury. J Spinal Cord Med 33:346–352

    PubMed  Google Scholar 

  20. Krödel A, Krüger A, Lohscheidt K, Pfahler M, Reflor HJ (1999) Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26

    PubMed  Google Scholar 

  21. 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 the vertebral osteomyelitis of the lumbar spine. Spine 23:1885–1890

    Article  PubMed  CAS  Google Scholar 

  22. Jain AK, Dhammi IK, Prashat B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Jt Surg B 90:1477–1481

    Article  CAS  Google Scholar 

  23. Stener B (1989) Complete removal of vertebrae for extirpation of tumors. Clin Orthop 245:72–82

    PubMed  Google Scholar 

  24. Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y (1997) Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 22:324–333

    Article  PubMed  CAS  Google Scholar 

  25. Halpern EM, Bacon SA, Kitagawa T, Lewis SJ (2010) Posterior transdiscal three-column shortening in the surgical treatment of vertebral discitis/osteomyelitis with collapse. Spine 35:1316–1322

    Article  PubMed  Google Scholar 

  26. 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 38:926–933

    Article  PubMed  CAS  Google Scholar 

  27. Hempelmann RG, Mater E, Schön R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19:1720–1727

    Article  PubMed  Google Scholar 

  28. Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Jt Surg B 88:765–770

    Article  CAS  Google Scholar 

  29. Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262

    Article  PubMed  Google Scholar 

  30. 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 28:302–308

    Google Scholar 

  31. Dai L, Chen W, Jiang L (2008) Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J 17:1027–1034

    Article  PubMed  Google Scholar 

  32. Ruf M, Stoltze D, Merk HR, Ames M, Harms J (2007) Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages. Spine 32:275–280

    Article  Google Scholar 

  33. 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 15:149–156

    Article  PubMed  Google Scholar 

  34. 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 12:606–612

    Article  PubMed  CAS  Google Scholar 

  35. Yong HP, Jong DP, Young-Geun C, Sang-Ho L (2009) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8:405–412

    Google Scholar 

  36. Walter J, Kuhn SA, Reichart R, Kalff R, Ewald C (2010) PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series. Eur Spine J 19:1004–1009

    Article  PubMed  Google Scholar 

  37. Mondorf Y, Gaab MR, Oertel JM (2009) PEEK cage cervical ventral fusion in spondylodiscitis. Acta Neurochir 151:1537–1541

    Article  PubMed  Google Scholar 

  38. Cavuşoğlu H, Kaya RA, Türkmenoğlu ON, Tuncer C, Colak I, Aydin Y (2008) A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 8:30–38

    Article  PubMed  Google Scholar 

  39. Blondel B, Fuentes S, Pech-Gourg G, Metellus P, Dufour H (2011) Minimally invasive osteosynthesis in septic conditions. Neurochirurgie 57:15–20

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Surgery Unit, University Medical Centre, Ljubljana, Slovenia

    M. Gorensek, R. Kosak, L. Travnik & R. Vengust

Authors
  1. M. Gorensek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Kosak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Travnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Vengust
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Vengust.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gorensek, M., Kosak, R., Travnik, L. et al. Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine. Eur Spine J 22, 633–641 (2013). https://doi.org/10.1007/s00586-012-2487-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2487-5

Keywords

Search

Navigation