Use of structural allografts in spinal osteomyelitis: a review of 47 cases.
OBJECTIVE
The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]).


METHODS
Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14-83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 +/- 9 months (median 14 months, range 6-45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure.


CONCLUSIONS
It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.
Schuster
J M
JM
Department of Neurological Surgery, Harborview Injury Prevention and Research Center, Seattle, Washington 98104, USA.
Avellino
A M
AM
Mann
F A
FA
Girouard
A A
AA
Grady
M S
MS
Newell
D W
DW
Winn
H R
HR
Chapman
J R
JR
Mirza
S K
SK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001799:Blood Sedimentation; D016025:Bone Transplantation / Q000000981:diagnostic imaging / Q000379:methods*; D019299:Decompression, Surgical; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices / Q000382:microbiology; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013203:Staphylococcal Infections; D015819:Substance Abuse, Intravenous / Q000150:complications; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000382:microbiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications
D000900:Anti-Bacterial Agents