The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis.
OBJECTIVE
The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented.


METHODS
Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12-L1), 5 lumbar, and 3 lumbosacral (involving L5-S1) lesions. The most frequently identified organisms were Staphylococcus aureus, Mycobacterium tuberculosis, and Coccidioides immitis. Imaging studies included x-rays, computed tomographic scans, and magnetic resonance imaging scans. All patients were treated with corpectomies and expandable cage reconstruction. Fusion was performed with rib autograft, iliac crest autograft, or allograft. Most patients who had an anterior approach also underwent posterior instrumentation, whereas a few had anterior instrumentation only. Four patients underwent a posterior approach (transpedicular corpectomy) only.


RESULTS
The median follow-up period was 21 months. There were no implant failures. Two recurrences of infection were noted: 1 case involved allograft, and the other involved autograft. At follow-up, neurological deficits improved in all patients, and 81% of patients were pain-free.


CONCLUSIONS
This study suggests that the treatment of vertebral column osteomyelitis can be performed with expandable titanium cages, and allograft does not appear to increase the rate of recurrence, as compared with autograft.
Lu
Daniel C
DC
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143-0350, USA.
Wang
Vincent
V
Chou
Dean
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013131:Spine / Q000601:surgery*; D014025:Titanium; D014182:Transplantation, Autologous / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
D014025:Titanium