Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade.
BACKGROUND
Surgical treatment of hematogenous pyogenic spondylitis and spondylodiskitis includes anterior debridement, stabilization, and fusion. Titanium mesh cage (TMC) has been advocated to immediately correct deformity and eradicate infection with low recurrence rates. There are no comprehensive reviews on TMC.


OBJECTIVE
To evaluate recorded information regarding surgical outcome with the use of TMC for treating patients with pyogenic spinal infection.


METHODS
Comprehensive review.


METHODS
The terms "titanium cage", "spine", "infection" were searched. A total of 486 peer-reviewed papers published from 2002 to 2012 were obtained from PubMed search. Fifteen Level IV articles with 363 patients were enrolled for consideration. Finally, 192 (53 %) patients who received TMC were eligible and included in this review. Age, comorbidities, indications for surgery, abscess formation, time lapsed between symptoms initiation and surgery, microbiology, radiological spine restoration, neurological outcome, and complications following surgery are evaluated.


RESULTS
The average age at the index surgery was 57 years, range 15-85 years. The reported time lapsed from symptoms presentation to diagnosis varied significantly from 1 week to 2 years. On admission, there reported paravertebral and/or epidural abscess in 48 % and neurological impairment in 51 % of the patients. One hundred and seventy-seven comorbidities were recorded in 192 patients. Bone biopsy and culture revealed gram (+) bacteria in 71 %, gram (-) in 24 %, and multiple bacteria in 1 %, while it was negative in 3.1 % of the patients. TMC was most commonly (49 %) implanted in the lumbar spine. The follow-up observation following surgery averaged 26 months, range 10-116 months. Most of the studies reported decrease in segmental kyphosis and neurological improvement in incomplete lesions postoperatively. TMC was primarily revised for early dislodgment or cage misplacement in 3.2 % of the patients. Infection recurrence was recorded in two patients (1.3 %), but revision surgery needed in one (0.65 %) patient. Mortality was reported in 5.8 % of the patients.


CONCLUSIONS
TMC offers an advantageous and safe technique for spinal debridement and fusion for hematogenous spinal infection. TMC safeguarded medium-term spinal stability with low infection recurrence rates, which were independent form causative pathogen, age, and comorbidities.
Orthopaedic Department, General Hospital Patras, Tsertidou 1 Str, Patras, Greece. korovessis@agandreashosp.gr.
Panagiotis
P
Korovessis
Orthopaedic Department, General Hospital Patras, Tsertidou 1 Str, Patras, Greece.
Konstantinos
K
Vardakastanis
Orthopaedic Department, General Hospital Patras, Tsertidou 1 Str, Patras, Greece.
Peter
P
Fennema
Orthopaedic Department, General Hospital Patras, Tsertidou 1 Str, Patras, Greece.
Vasileios
V
Syrimbeis
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015299:Discitis / Q000000981:diagnostic imaging / Q000601:surgery*; D016905:Gram-Negative Bacterial Infections / Q000000981:diagnostic imaging / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D061214:Patient Safety; D013166:Spondylitis / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D014025:Titanium / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D014025:Titanium
Hematogenous; Spondylitis; Spondylodiskitis; Titanium mesh cage