title: Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion.
abstract: METHODS
  Case series.
  
  
  OBJECTIVE
  The results of surgical treatment of osteomyelitis with anterior debridement and fusion followed by delayed posterior stabilization and fusion are presented.
  
  
  METHODS
  Forty-two patients with vertebral osteomyelitis are presented. There were 5 cervical, 12 thoracic, 1 thoracolumbar, 19 lumbar, and 5 lumbosacral lesions. The most frequently identified organism was Staphylococcus aureus. Most patients had significant comorbidities, including diabetes, or were immunocompromised. Ninety percent had elevated erythrocyte sedimentation rates and C-reactive proteins, while white blood cell counts were less reliably elevated. Imaging studies included radiographs, CT scans, and MRIs. All patients were treated with anterior debridement and strut grafting followed by 14.4 days of intravenous antibiotics and delayed instrumented posterior fusions and received 6 weeks of intravenous antibiotics after surgery.
  
  
  RESULTS
  All patients had resolution of their infections with no recurrence. There were two deaths. Neurologic deficits resolved in all patients. The diagnosis of pyogenic vertebral osteomyelitis is frequently delayed and presents a significant surgical challenge. The indications for surgical debridement were neurologic compromise, failed medical treatment, soft tissue extension, extensive vertebral body and disc space destruction, and progressive deformity. Many of these patients were severely ill at presentation and required urgent treatment. Anterior debridement and fusion followed by intravenous antibiotics allows for restoration of anterior column support and control of the infection before posterior instrumentation and fusion.
  
  
  CONCLUSIONS
  This study demonstrates that anterior surgical debridement with fusion, followed by a period of intravenous antibiotics and delayed instrumented posterior fusion, is highly effective in the treatment of pyogenic osteomyelitis that has failed medical management.
authors.affiliation: Leatherman Spine Center, Louisville, Kentucky, USA. cthomas@spinemds.com
authors.forename: John R
authors.initials: JR
authors.lastname: Dimar
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Campbell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hartman
authors.forename: John R
authors.initials: JR
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D013123:Spinal Fusion; D013166:Spondylitis / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000628:therapy*