Posterior fixation without debridement for vertebral body osteomyelitis and discitis
| Autor: | Jung U. Yoo, Robert A. Hart, D. Kojo Hamilton, Ahmed S. Mohamed, Brian T. Ragel, Jayme Hiratzka, Alexander C. Ching, Penelope D. Barnes |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Spondylodiscitis
Male medicine.medical_specialty Discitis medicine.medical_treatment Posterior approach Thoracic Vertebrae Posterior fixation Deformity Medicine Humans Longitudinal Studies Aged Retrospective Studies Debridement business.industry Osteomyelitis General Medicine Middle Aged medicine.disease Decompression Surgical Magnetic Resonance Imaging Surgery Vertebral body Spinal Fusion Female Neurology (clinical) medicine.symptom business Tomography X-Ray Computed |
| Zdroj: | Neurosurgical focus. 37(2) |
| ISSN: | 1092-0684 |
| Popis: | Object The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach. The authors present their results using an alternative treatment method of posterior-only neuro-decompression and stabilization without formal debridement of anterior tissue for treating spontaneous spinal infection. Methods Fifteen consecutive patients were treated surgically by 2 of the authors. All patients had osteomyelitis and discitis and were treated postoperatively with intravenous antibiotics for at least 6 weeks. The indications for surgery were failed medical management, progressive deformity with ongoing persistent spinal infection, or neurological deficit. Patients with simple epidural abscess without bony instability were treated with laminectomy and were not included in this series. Fourteen patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area. One patient was treated with staged anterior and posterior surgery due to delay in treatment related to medical comorbidities. The authors examined as their outcome the ambulatory status and recurrence of deep infection requiring additional surgery or medical treatment. Results Of the initial 15 patients, 10 (66%) had a minimum 2-year follow-up and 14 patients had at least 1 year of followup. There were no recurrent spinal infections. There were 3 unplanned reoperations (1 for loss of fixation, 1 for early superficial wound infection, and 1 for epidural hematoma). Nine (60%) of 15 patients were nonambulatory at presentation. At final followup, 8 of 15 patients were independently ambulatory, 6 required an assistive device, and 1 remained nonambulatory. Conclusions Long-segment fixation, without formal debridement, resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. This surgical technique, when combined with aggressive antibiotic therapy and a multidisciplinary team approach, is an effective way of managing serious spinal infections in a challenging patient population. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|