title: Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases.
abstract: BACKGROUND
  The treatment of methicillin-resistant Staphylococcus aureus (MRSA) spondylodiscitis is reported to be far more difficult than that of non-MRSA spondylodiscitis. At present, there seems to be no standard protocol for the treatment of MRSA spondylodiscitis cases in which conservative management has failed.
  
  
  METHODS
  Between 1998 and 2001, five patients (aged 48-73 years; average: 63.8 years; SD: 9.9) with MRSA spondylodiscitis were treated surgically after conservative treatment had failed. Posterior spinal instrumentation was performed for all five patients, three of whom also underwent anterior debridement and bone graft. All the patients had neurological deficits and severe pain. To assess the invasiveness of the operation, we evaluated operating time, blood loss, and complications. Pain (verbal rating scale; VRS), neurological status (Frankel type), activities of daily living (ADL) (the Barthel index), WBC, CRP, and ESR in the preoperative, postoperative and final follow-up periods were used to evaluate the surgical outcomes.
  
  
  RESULTS
  Although we encountered several postoperative complications including deep wound infections, at the final follow-up visit, the neurological deficits, activities of daily living, Barthel index, and VRS had improved in all the patients. Changes in WBC, CRP, and ESR revealed suppression of infection in all patients.
  
  
  CONCLUSIONS
  Surgical treatment for MRSA spondylodiscitis with posterior spinal instrumentation provided patients with satisfactory final outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, Gifu-pre., 501-1194, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sakaeda
authors.forename: Mizuo
authors.initials: M
authors.lastname: Tanaka
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D001858:Bone Nails; D003646:Debridement; D015299:Discitis / Q000150:complications / Q000382:microbiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000601:surgery; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000628:therapy; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery*; D013211:Staphylococcus aureus / Q000187:drug effects; D013904:Thoracic Vertebrae / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome