There is no scientific consensus on the role of posterior instrumentation in vertebral osteomyelitis. No study has examined the use of titanium cages to reconstruct the anterior column of the spine with vertebral osteomyelitis. Here the authors evaluated the efficacy of using titanium mesh cages anteriorly and posterior instrumentation after anterior debridement in the surgical treatment of vertebral osteomyelitis. In one center, 21 consecutive patients had surgery for vertebral osteomyelitis. The mean follow-up time was 67 months (range, 24 to 120 months). Ten patients received supplemental posterior instrumentation. Five patients had reconstruction of the anterior column with titanium cages. Greater improvement in sagittal alignment was noted for patients with cages implanted (p = 0.0009) and for those with posterior instrumentation (p = 0.005). Patients who received cages had greater (p = 0.0006) correction of their coronal alignment than did those patients without cages. A trend toward fewer postoperative complications emerged for patients who had posterior stabilization or titanium cages. These results support the use of posterior stabilization and titanium cages in the surgical treatment of vertebral osteomyelitis.

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The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.

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