Anterior Fusion of the Spine for Infective Lesions in Adults

Abstract

1. The results of treatment of 117 tuberculous and fourteen other types of infection of the spine in adults by anterior fusion and chemotherapy have been reviewed. 2. It is suggested that anterior fusion is justified because: a) it permits isolation of the organism, and hence the determination of drug sensitivities and appropriate chemotherapy; b) removal of the diseased tissue and the stabilisation of the affected segment by iliac bone grafts can be effected, leading to rapid healing by bony fusion with little further collapse; c) rehabilitation of the patient is hastened; and d) the incidence of reactivation is probably diminished.

Vertebral osteomyelitis: an analysis of 38 surgically treated cases

“…Resection of hypovascular infected vertebral bone and disc tissue facilitates the control of micro-organisms by improving local blood supply [2,9,15], which leads to the adequate concentration of antimicrobial drugs in the local tissue. Autogenous iliac crest grafting, which promotes rapid healing without collapse, should extend from healthy bone above to healthy bone below [4,8,9]. In the present selected patients, who required anterior debridement and bone grafting for this disease, the prognosis was quite good after surgery in conjunction with antibiotics therapy, as previous authors have advocated [5,9,14].…”

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

“…For decades the gold standard has been an anterior debridement and in-situ fusion [9,10,13,16]. However, an increasing number of studies advocate a combination of posterior stabilisation and anterior debridement and interbody fusion.…”

Primary reconstruction for spinal infections

“…[13,23,30] An anterior surgical approach was used to allow direct access to the infectious foci for aggressive debridement. [9,[17][18][19][20] Aggressive anterior debridement, however, requires reconstruction to prevent spinal deformity. Autologous interbody bone grafting in the presence of active infection was first reported by Wiltberger [38] in 1952 for chronic vertebral osteomyelitis and has been used safely since then.…”

“…Autologous interbody bone grafting in the presence of active infection was first reported by Wiltberger [38] in 1952 for chronic vertebral osteomyelitis and has been used safely since then. [10,17,18,20] Although autologous iliac crest bone grafts are preferred, [17,18,28] vascularized rib grafts have been used successfully and fibula grafts have been shown to be effective in the cervical spine. [1,37] Posterior stabilization and fusion are indicated for significant spinal deformities or for procedures performed at the thoracolumbar junction.…”

“…[1,37] Posterior stabilization and fusion are indicated for significant spinal deformities or for procedures performed at the thoracolumbar junction. [11,18,19,22,28] The use of spinal instrumentation in the context of infection has not been thoroughly addressed in the literature. Currier and Eismont [5] reported instrumentation of the thoracolumbar spine for T10-11 discitis and osteomyelitis with associated epidural abscess, but did not discuss the role of spinal instrumentation in this context.…”