title: Single-level/single-stage debridement and posterior instrumented fusion in the treatment of spontaneous pyogenic osteomyelitis/discitis: long-term functional outcome and health-related quality of life.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To support single-level posterior debridement and instrumented interbody fusion as a single-stage procedure for spontaneous pyogenic osteomyelitis/discitis.
  
  
  BACKGROUND
  The best surgical technique for patients with bacterial spinal infections is still a matter of debate. Recent publications suggest that titanium implants can be used safely in the infectious sites in combination with debridement and antibiotic therapy.
  
  
  METHODS
  We retrospectively review patients with spontaneous pyogenic osteomyelitis/discitis in whom medical therapy failed, and they consequently underwent posterior decompression and instrumented fusion. Data was collected regarding demographics, clinical presentation, images and laboratory studies, antibiotic treatment, duration of hospitalization, time to achieve radiologic evidence of fusion, postoperative complications, and neurologic function pre- and postoperatively. Quality of life was measured using the EQ5D questionnaire and level of disability with the Oswestry Disability Index.
  
  
  RESULTS
  Nine patients, ranging in age from 41 to79 years, with a Frankel score of D in 7 cases and of E in 2 cases, underwent a single-level/single-stage debridement and posterior instrumented fusion with pedicle screws and an interbody and posterolateral autogenous bone graft. Preoperative neurologic deficits improved in all the cases and solid bone fusion was achieved in all 9 patients at 12 months. The mean follow-up period was 67 months. The infection healed after surgery in all the patients and they did not require a second operation to remove the metal implants. Quality of life assessed with the EQ5D questionnaire showed scores ranging between 0.70 and 1. The median Oswestry Disability Index was 15.5%.
  
  
  CONCLUSIONS
  These findings support that debridement and posterior instrumented fusion can be performed as a single-stage procedure with no increase in the recurrence rate or morbidity. The outcome has been satisfactory in our patients in terms of the rate of fusion and quality of life.
authors: Department of Neurosurgery, Austin Hospital, Melbourne, Australia. augusto.gonzalvo@gmail.com
authors: Augusto
authors: A
authors: Gonzalvo
authors: Irfan
authors: I
authors: Abdulla
authors: Arash
authors: A
authors: Riazi
authors: David
authors: D
authors: De La Harpe
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003646:Debridement / Q000295:instrumentation / Q000379:methods*; D004185:Disability Evaluation; D015299:Discitis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome