title: Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis.
abstract: METHODS
  A retrospective analysis was performed of the clinical outcomes of patients with pyogenic or tuberculotic spondylitis who were treated with two-stage surgery (first stage: placement of posterior instrumentation; second stage: anterior debridement and bone grafting).
  
  
  OBJECTIVE
  To evaluate the clinical outcomes of the abovementioned two-stage surgical treatment for pyogenic or tuberculotic spondylitis.
  
  
  BACKGROUND
  Although several methods of surgical treatment for pyogenic and tuberculotic spondylitis have been reported, there have been few reports of two-stage surgical treatment.
  
  
  METHODS
  Eight patients (7 male, 1 female) with pyogenic or tuberculotic spondylitis (pyogenic: 6; tuberculotic: 2) were treated by two-stage surgery (first: placement of posterior instrumentation, second: anterior debridement and bone graft). Age at the time of surgery was 63.5 +/- 9.91 years (average +/- SD) (range: 47 to 77 years). Most of the patients had systemic problems, such as pneumonia, diabetes mellitus, or chronic renal failure. First, posterior spinal instrumentation was placed. Then, anterior debridement and bone grafting were performed. Patients were evaluated before and after surgery in terms of pain level, hematologic parameters, neurologic status, and Barthel index.
  
  
  RESULTS
  Average duration of surgery for both procedures was less than 4 hours. Changes in the pain level, blood parameters, and Barthel index demonstrated significant clinical improvement in all patients. Posterior wound infection occurred in two patients who were in poor general condition.
  
  
  CONCLUSIONS
  This two-stage surgical treatment for pyogenic or tuberculotic spondylitis provided satisfactory results and can also be used in patients who are in poor general condition.
authors.affiliation: Department of Orthopaedic Surgery, Gifu University School of Medicine, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Fukuta
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kodama
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nishimoto
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sakaeda
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001799:Blood Sedimentation; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013166:Spondylitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000188:drug therapy / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein