Anterior interbody fusion for cervical osteomyelitis: Reversal of quadriplegia after evacuation of epidural spinal abscess

Abstract

SUMMARY Interbody fusion for stabilization of the cervical spine after osteomyelitic destruction of the body of C5 vertebra is reported in a patient with quadriplegia and sphincter disturbances secondary to an epidural abscess. The successful union of the bone graft along with complete neurological recovery after anterior decompression and evacuation of the epidural mass seem to justify the procedure.The management of cervical osteomyelitis complicated by spinal epidural abscess was reviewed in a number of papers (Allbrook, 1949;Durity and Thompson, 1968;Hutton, 1956; Rimalowski and Aronson, 1968), stressing the extreme urgency of the condition and the generally disappointing results of surgery. The standard posterior approach by laminectomy was generally used to decompress the spinal cord.When, however, the epidural abscess develops in association with a compression fracture and dislocation of the vertebral body due to osteomyelitic destruction as in the following case, the posterior approach is obviously inadequate for a thorough debridement. The successful treatment of an epidural spinal abscess complicated by osteomyelitic destruction of the C5 vertebral body by the anterior approach is pres-ented. An autogenous bone graft was used to fill the gap caused by the removal of the destroyed vertebral body and adjacent discs. The satisfactory union of the bone graft and the remarkable neurological recovery prompted this communication. CASE REPORTThe patient was a 26 year old soldier wounded during action by bazooka fragments in the face, neck, shoulders, and right upper arm. Tracheostomy and enucleation of the right eye had been performed at another hospital along with local cleansing of the wounds under penicillin and streptomycin cover.

Spinal epidural abscess: a meta-analysis of 915 patients

“…Maslen et al [231] reported a mean of 67 years of age in a group of 28 patients with SEA, which represents the highest average age in all published case series [16,31,73,74,80,81,98,141,154,172,177,189,201,212,213,231,235,253,283,297,300,306,316,370,391,401]. However, Dei-Anang et al [80] included in their patient group four children aged 2 to 6 as well as five patients from 19 In this review, articles published between 1954 and 1997 concerning a total of 915 patients with SEA were statistically analyzed [1, 3-5, 11-14, 16, 17, 24, 31-33, 35-40, 43-46, 50, 55, 57-61, 63, 65, 66, 70, 71, 73, 74, 77, 79-81, 84-86, 89, 92-94, 96-100, 103-108, 110, 115-117, 121-124, 126-128, 133, 134, 137, 138, 141-143, 146-149, 152, 154, 156, 158, 160, 161, 166, 168, 170, 172, 176-178, 180-182, 184-189, 191, 193, 194, 198-202, 204, 206, 208, 211-217, 220, 222-227, 229, 231-233, 235, 237, 240-242, 244, 245, 250, 253, 254, 256, 259, 260, 264-266, 269-271, 273, 276-278, 280, 283, 293, 294, 297-300, 303-306, 308, 311, 315-318, 321, 324, 326-328, 330, 332, 335, 336, 339, 341-343, 345-348, 351, 352, 354, 357-359, 362, 365, 370, 372, 373, 379-385, 388, 390, 391, 395, 397-399, 401, 403]. Some publications did not include detailed information on patient age [16,31,55,…”

“…A dissertation from 1962 [333] in the Cologne University Department of Neurosurgery evaluates results obtained with three patients as well as only 100 other cases from the literature, with special attention to reports of SEA following vertebral osteomyelitis. In the present work, the numerous published cases of SEA following purulent or tuberculous vertebral osteomyelitis are not included [7,10,19,29,53,62,75,88,109,130,132,135,139,144,162,165,169,171,190,205,207,219,228,236,272,281,282,285,307,340,344,363,364,371,387]. These cases were excluded from the present analysis because SEA following purulent or tuberculous vertebral osteomyelitis is clearly different from SEA of other etiology with respect to therapy and prognosis, with vertebral rather than epidural infection being the primary clinical problem.…”

Reversal of tetraplegia in patients with cervical osteomyelitis – epidural abscess using anterior debridement and fusion

“…The use of anterior debridement and fusion for nontuberculous cervical osteomyelitis/epidural abscess (COEA) was ®rst described in the medical literature by Bartal et al in 1972. 1 Since that initial report other authors have described the use of anterior surgery for COEA.…”

“…1 Since that initial report other authors have described the use of anterior surgery for COEA. 2 ± 7 However, there are few reports regarding the neurologic outcome in the most neurologically impaired patients (tetraplegic).…”