title: Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature.
abstract: BACKGROUND
  Percutaneous augmentation with bone cement is a widely accepted modality of treatment for thoracic and lumbar vertebral osteoporotic fractures. Infection after vertebroplasty or kyphoplasty is a serious, yet, rarely reported complication.
  
  
  OBJECTIVE
  To present a case series with a long-term follow-up of spinal infection after vertebroplasty/kyphoplasty with analysis of preoperative condition, risk factors, diagnostic findings, time before reoperation, causative organism, treatment, and outcome.
  
  
  METHODS
  A retrospective, uncontrolled clinical case series in a single institution.
  
  
  METHODS
  Between January 1997 and June 2012, 1,307 patients underwent percutaneous vertebroplasty or kyphoplasty. Six cases had postoperative infection (0.46%) and three additional cases were referred from other institutions for salvage treatment.
  
  
  METHODS
  Perioperative assessment included visual analog scale, clinical, laboratory, and imaging findings, and activities of daily living at the end of the follow-up.
  
  
  METHODS
  Nine patients were included: six females and three males (mean age 73.8 years). Comorbidities were found in all patients. Kyphoplasty had been done in five patients and vertebroplasty in four.
  
  
  RESULTS
  The interval between augmentation and revision surgery ranged from 10 to 395 days with a mean of 118.4 days. Three cases with early infection presented within 1 month. Infection parameters were high in all patients at readmission. All patients were treated surgically except one case who died before the planned revision surgery. In all cases, debridement and corpectomy were done through anterior approaches combined with posterior instrumentation. The most common causative organism was Staphylococcus aureus in three cases. Mean follow-up period after the revision surgery was 26.68 months, excluding two patients who died early in the follow-up (within 4 months). This amounts to a mortality rate of 33.3% perioperatively. At the end of follow-up, two patients had unrestricted activities and one patient required a walker. Of three paraparetic patients, two improved functionally and could walk unassisted and one improved but still used a wheelchair.
  
  
  CONCLUSIONS
  Although vertebroplasty and kyphoplasty are minimally invasive interventions, postoperative infection can develop into life-threatening complications. This should be accounted for, in decision making in the elderly age group most commonly affected by osteoporotic fractures and especially in suspicious and high-risk immune-compromised patients.
authors.affiliation: Department of Spinal Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99438 Bad Berka, Germany; Department of Orthopedics and Traumatology, Assiut University, Assiut, Egypt.
authors.forename: Hamdan
authors.initials: H
authors.lastname: Abdelrahman
authors.forename: Ahmed Ezzat
authors.initials: AE
authors.lastname: Siam
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shawky
authors.forename: Ali
authors.initials: A
authors.lastname: Ezzati
authors.forename: Heinrich
authors.initials: H
authors.lastname: Boehm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology*; D058498:Kyphoplasty / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D054854:Vertebroplasty / Q000009:adverse effects*
keywords: Kyphoplasty; Spinal infection; Spondylitis; Spondylodiscitis; Vertebroplasty