Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis.
BACKGROUND
Vertebral osteomyelitis can be successfully treated with spinal immobilization and parenteral antibiotics. Failure of medical therapy may necessitate surgical treatment consisting of anterior debridement and structural anterior column reconstruction. Autologous structural bone graft has traditionally been the gold standard in anterior column reconstruction. Because of the morbidity related to graft harvest, vertebral body replacement cages have emerged as a viable option for reconstructing a deficient anterior column.


OBJECTIVE
To evaluate the efficacy of titanium mesh cages in the reconstruction of anterior column defects in the presence of active pyogenic infection.


METHODS
Prospective case series.


METHODS
Eleven patients underwent operative treatment for osteomyelitis of the thoracolumbar spine using staged anterior debridement and reconstruction with cylindrical titanium mesh cages followed by delayed posterior spinal fusion with pedicle screw instrumentation during a 2-year period. Patients were postoperatively evaluated clinically and radiographically.


RESULTS
Follow-up averaged 17+/-9 months. Average increase in kyphosis of 10+/-6 degrees corresponding to 4+/-4 mm loss in the height (subsidence) of the anterior construct. One patient died during revision surgery for hardware failure. Seven of the remaining 10 patients have not required antibiotics after the initial postoperative course of treatment. Three patients are maintained on chronic suppressive therapy as a precaution. There has been no evidence of recurrence or residual infection in any patient. Seven of the 10 patients were pain free at latest follow-up. There has been one case of pseudarthrosis.


CONCLUSIONS
Cylindrical titanium mesh can be used with consistently good results for large anterior column defect reconstructions even in the face of active pyogenic infection. In our cohort of patients with pyogenic vertebral osteomyelitis, the use of titanium mesh cages has not been associated with early recurrence of infection.
Fayazi
Amir H
AH
Department of Orthopaedics and Rehabilitation, The Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
Ludwig
Steven C
SC
Dabbah
Michael
M
Bryan Butler
R
R
Gelb
Daniel E
DE
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013166:Spondylitis / Q000382:microbiology* / Q000601:surgery*; D013526:Surgical Mesh; D013904:Thoracic Vertebrae / Q000503:physiopathology; D014025:Titanium; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D014025:Titanium