Safety of instrumentation and fusion at the time of surgical debridement for spinal infection.
The present study aims to assess the results of single-stage instrumentation and fusion at the time of surgical debridement of spinal infections; vertebral osteomyelitis or epidural abscess. Nine patients with spinal infection were treated with instrumentation and fusion after radical debridement in a single-stage operation. Predisposing factors and comorbidities, pain, American Spinal Injury Association motor scores, primary pathologies, microbiology and perioperative markers were recorded. Seven patients with pyogenic and two with tuberculous spinal infection were encountered; the most common pathogen was Staphylococcus aureus. Five patients were predisposed to infection because of diabetes mellitus. Duration of antibiotic therapy lasted up to 12 months. Six patients had thoracic infection, two lumbar and one cervical. No post-operative complications were encountered. There was a significant reduction in pain scores compared to pre-operatively. All patients with neurological deficits improved post-operatively. Despite introduction of hardware, no patients had a recurrence of their infection in the 12 month follow up period. Single-stage debridement and instrumentation appeared to be a safe and effective method of managing spinal infections. The combination of debridement and fusion has the dual benefit of removing a focus of infection and stabilising the spine. The current series confirms that placing titanium cages into an infected space is safe in a majority of patients. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. The small patient population and retrospective nature limit the present study.
Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia. Electronic address: ajtalia@gmail.com.
Adrian J
AJ
Talia
Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
Michael L
ML
Wong
Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
Hui C
HC
Lau
Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
Andrew H
AH
Kaye
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002494:Central Nervous System Infections / Q000601:surgery*; D003131:Combined Modality Therapy; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000379:methods; D010146:Pain / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013203:Staphylococcal Infections / Q000150:complications / Q000601:surgery / Q000628:therapy; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D014025:Titanium
Expandable cage; Instrumentation; Spinal fusion; Spinal infection; Surgical debridement