title: Comparison of Instrumented and Noninstrumented Surgical Treatment of Severe Vertebral Osteomyelitis.
abstract: The purpose of this study was to compare the outcomes of instrumented versus noninstrumented (decompression) surgical treatment of vertebral osteomyelitis. The study population included 104 patients with spinal osteomyelitis who were treated at the authors' institution between 2004 and 2012. This included 62 men and 42 women who underwent either instrumented (n=57) or noninstrumented (n=47) surgery. Mean patient age was 59 years, and mean follow-up was 38 months (range, 12-78 months). Specifically, the following criteria were assessed: mortality rates, infection clearance rates, clinical outcomes measured by Oswestry Disability Index (ODI), mean length of stay, and baseline differences between the 2 cohorts. Although patients in the instrumented cohort had more instability, more neurologic symptoms, and larger volume infection, they had similar clearance of infection (54% vs 42.5%; odds ratio [OR], 1.55; 95% confidence interval [CI], 0.61-3.9; P=.35), mortality rate (9% vs 17%; OR, 0.47; 95% CI, 0.14-1.54; P=.21), and ODI scores (40 vs 45 points; P=.32) compared with patients in the noninstrumented group. However, mean length of stay (19 vs 13 days; P=.02) was significantly higher for patients in the instrumented group. Even in more severe cases of vertebral osteomyelitis, instrumentation resulted in comparable outcomes to decompression. [Orthopedics. 2016; 39(3):e504-e508.].
authors.forename: Sina
authors.initials: S
authors.lastname: Pourtaheri
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.forename: Tyler
authors.initials: T
authors.lastname: Stewart
authors.forename: Eiman
authors.initials: E
authors.lastname: Shafa
authors.forename: Remi
authors.initials: R
authors.lastname: Ajiboye
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Buerba
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lord
authors.forename: Ki
authors.initials: K
authors.lastname: Hwang
authors.forename: Daniel
authors.initials: D
authors.lastname: Mangels
authors.forename: Arash
authors.initials: A
authors.lastname: Emami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult