title: Two-stage management for vertebral osteomyelitis and epidural abscess: technical note.
abstract: OBJECTIVE
  The incidence of spinal infections has increased in recent years, and vertebral osteomyelitis and epidural abscess are issues of great concern for spine surgeons. We retrospectively reviewed our cases treated by two-stage management for vertebral osteomyelitis and epidural abscess.
  
  
  METHODS
  The series consisted of nine patients (five men and four women); their ages ranged from 49 to 77 years (mean age, 60.6 yr). Coexisting medical conditions were diabetes mellitus in one case and long-term steroid intake in another. Myelopathy or radicular pain was caused by osteomyelitis and an epidural abscess in all patients. Cervical, thoracic, and lumbar osteomyelitis was detected in three, four, and two patients, respectively; epidural abscess was pyogenic in four patients, tuberculous in three, and unknown in two patients. Our surgical strategy involved anterior debridement or drainage and application of an external orthosis postoperatively during the first stage. After clinical control of the infection by using organism-specific intravenous antibiotics as far as possible, as confirmed by normal erythrocyte sedimentation rate and/or C-reactive protein, second stage surgery was performed. This included complete debridement of all necrotic bone and soft tissues, and stable reconstruction with or without instrumentation (six and three patients, respectively).
  
  
  RESULTS
  The postoperative course was uneventful with relief of the symptoms after the second surgery. No evidence of recurrence or residual infection was observed in any patient, as shown by erythrocyte sedimentation rate and/or C-reactive protein levels during a follow-up period averaging 26.6 months (range, 2-56 mo).
  
  
  CONCLUSIONS
  Without denying the efficacy of the single-stage surgery, two-stage management can be a reasonable alternative for carefully selected patients who have spinal infection.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan. nakasehi@naramed-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Matsuda
authors.forename: Ryo
authors.initials: R
authors.lastname: Tamaki
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: D000368:Aged; D020802:Epidural Abscess / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016268:Internal Fixators; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome