title: Delayed reconstruction by titanium mesh-bone graft composite in pyogenic spinal infection: a long-term follow-up study.
abstract: OBJECTIVE
  Use of instrumentation in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. Particularly, limited information is available regarding the long-term follow-up of patients. We retrospectively reviewed the use of titanium mesh-bone graft composite after corpectomy in pyogenic spinal infection with a minimum 3-year follow-up outcome.
  
  
  METHODS
  Four patients, two men and two women, with cervical and thoracic myelopathy caused by cervical (two cases) and thoracic (two cases) osteomyelitis and epidural abscess, were treated. Their age ranged from 49 to 74 years (mean age 58 years). In one case, the coexisting medical condition was diabetes. Neurologic deficits caused by direct spinal cord compression due to epidural abscess, segmental deformity, and instability were observed in all cases. After infection was clinically controlled by intravenous antibiotics, anterior debridement and fusion using titanium mesh cage along with anterior plate were performed. Two-stage treatment was performed in two cases.
  
  
  RESULTS
  The postoperative course was uneventful; all patients experienced relief of symptoms. No evidence of recurrence or residual infection was observed in any patient during the average follow-up period of 42-56 months (average 49.0 months).
  
  
  CONCLUSIONS
  Once infection is clinically controlled, a titanium mesh-bone graft composite and plate in combination with aggressive debridement might provide an effective therapy for spinal osteomyelitis requiring surgery. Despite studying a small number of patients, we can conclude that titanium mesh reconstruction can be useful as a surgical method in selected low-risk patients with vertebral osteomyelitis.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. nakasehi@naramed-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
authors.forename: Ryo
authors.initials: R
authors.lastname: Tamaki
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Matsuda
authors.forename: Rinsei
authors.initials: R
authors.lastname: Tei
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Park
authors.forename: Toshisuke
authors.initials: T
authors.lastname: Sakaki
mesh_terms: D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery*; D017703:Retropharyngeal Abscess / Q000175:diagnosis; D012189:Retrospective Studies; D013123:Spinal Fusion; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D014025:Titanium