Instrumentation in patients with spinal infection

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Placement of instrumentation in the setting of a spinal infection has always been controversial. Although the use of allograft and autograft bone has been accepted as safe, demonstrations of the effectiveness of titanium have been speculative, based on several retrospective reviews. The authors' goal in this study was to demonstrate the effectiveness of instrumentation in the setting of a spinal infection by retrospectively reviewing their cases over the last 4 years and searching the literature regarding instrumentation in patients with pyogenic spinal infections.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors conducted a retrospective review of their cumulative data on spinal infections. Diagnosis was based on subjective and objective clinical findings, along with radiographic and laboratory evaluation of infection and mechanical stability. Patients with medically managed disease and those who did not receive instrumentation were eliminated from this review.</jats:p> <jats:p>Of 105 patients with spinal infections who were admitted to the neurosurgical service between January 2000 and June 2004, 30 underwent surgical debridement necessitating spinal instrumentation. There were 17 women and 13 men in this group ranging from 28 to 86 years of age. Follow-up duration ranged from 3 to 54 months. There was one death, which occurred 3 months postsurgery. In three patients a deep wound infection developed, necessitating intervention, and two patients experienced a graft expulsion. Twenty-nine patients went on to demonstrate adequate fusion based on follow-up neuroimaging studies.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The goal of neurosurgical intervention in the setting of spinal infection is to obtain an organism culture and the debridement of infection while maintaining neurological and mechanical stability. The authors demonstrate the effectiveness of radical debridement of infected bone and placement of instrumentation in patients with spinal infections.</jats:p></jats:sec>

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

“…The advocates for spinal instrumentation argued that stabilization of the spine is very important for the suppression and eventual elimination of infections [13,14]. Increasing evidence has also showed that instrumentation in the presence of active infection is well tolerated while spinal stability is maintained effectively with sufficient restoration of sagittal alignment of the spine and relatively shorter duration of bed rest [3,[14][15][16][17][18][19][20][21][22][23][24][25].…”

Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

“…Titanium offered the benefits of superior corrosion resistance, biocompatibility, resistance to glycocalyx formation, and reduced MRI artifact compared with stainless steel. 9 However, when comparing the mechanical properties of titanium to stainless steel, there is a reduction in stiffness, resistance to notch effects, and tolerance to cyclic loading. Thus, many surgeons still prefer stainless steel implants for long-segment or spinal deformity surgeries.…”

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

“…This is true for the thoraco-lumbar region [7,14,16,18,19,24], as well as for the cervical spine [15][16][17]24]. Furthermore, a direct comparison between autologous iliac bone strut and cages did not show a difference in clinical and imaging outcomes [22].…”

“…Safe use of expandable titanium cages has been demonstrated for the thoraco-lumbar region [18,19], but has not been reported yet in detail for the cervical spondylitic spine. Figures depicting the use of expandable cages in cervical vertebral body replacement are given in the papers published by Lee [17] and Acosta [1] in 2004 without going into details.…”