Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis*1

Fayazi, Amir H.; Ludwig, Steven C.; Dabbah, M; Butler, R. Bryan; Gelb, Daniel E.

doi:10.1016/j.spinee.2004.01.004

Cited by 121 publications

(105 citation statements)

References 21 publications

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“…In a staged anterior-posterior procedure, Fayazi et al (2004) used titanium-mesh cages in 11 patients with spondylodiscitis. One patient had to be reoperated because of hardware failure.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

et al. 2008

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Background and purpose The use of metal implants in large defects caused by spinal infection to support the anterior column is controversial, and relatively few results have been published to date. Despite the fact that there is bacterial adhesion to metal implants, the strong immunity of the highly vascularized spine because of rich muscle covering is unique. This possibly allows the use of metal implants, which have the advantage of high stability and reduced loss of correction. This is a retrospective study of patients with spondylodiscitis treated with metal implants.Patients and methods We retrospectively analyzed the outcome in 22 consecutive patients (mean age 69 (43-82) years, 15 men) with spondylodiscitis (20 lumbar and 12 thoracic discs) who had received an anterior titanium cage implantation. In 13 cases, the pathogen could be identified. Antibiotic treatment was continued for at least 12 weeks postoperatively.Results The mean follow-up was 36 (32-47) months. Healing of inflammation was confirmed by clinical, radiographic, and laboratory parameters. The mean VAS improved from 9.1 (6-10) preoperatively to 2.6 (0-6) at the final follow-up, and the mean Oswestry disability index was 17 (0-76) at the final follow-up.Interpretation Our findings highlight the high healing rate and stability when titanium implants are used. Prerequisites are a radical debridement, correction of deformity, and additional bony fusion by bone grafting. The increased stability, with facilitated patient mobilization, and the relatively little loss of correction using anterior and posterior implants are of considerable

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“…In a staged anterior-posterior procedure, Fayazi et al (2004) used titanium-mesh cages in 11 patients with spondylodiscitis. One patient had to be reoperated because of hardware failure.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

et al. 2008

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“…Therefore, addition of posterior instrumentation in a noncontaminated field seems to be a more logical choice of treatment modalities to avoid graft displacement and facilitate early rehabilitation [3,5,10,11,15,19,21,27,31,36,41,46]. In some cases treated with posterior instrumentation, a cyclindrical titanium cage filled with bone graft has been also used as an alternative to structural bone grafting [17,25,28,29,32,36,48]. The results showed that titanium mesh cages when supplemented with posterior instrumentation was effective and safe for pyogenic vertebral osteomyelitis, and offered a biomechanically stable support.…”

Section: Discussionmentioning

confidence: 99%

Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

2008

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Anterior radical debridement and bone grafting is popular in the treatment of pyogenic infection of the spine, but there remains great concern of placing instrumentation in the presence of infection because of the potentiality of infection recurrence after surgery. The objective of this study was to prospectively evaluate the efficacy and safety of anterior instrumentation in patients who underwent simultaneous anterior debridement and autogenous bone grafting for the treatment of pyogenic vertebral osteomyelitis. The series consisted of 22 consecutive patients who were treated with anterior debridement, interbody fusion with autogenous bone grafting and anterior instrumentation for pyogenic vertebral osteomyelitis of thoracic and lumbar spine. The patients were prospectively followed up for a minimum of 3 years (average 46.1 months; range 36-74 months). Data were obtained for assessing clinically the neurological function and pain and radiologically the spinal alignment and fusion progress as well as recurrence of the infection. All the patients experienced complete or significant relief of back pain with rapid improvement of neurological function. Kyphosis was improved with an average correction rate of 93.1% (range 84-100%). Solid fusion and healing of the infection was achieved in all the patients without any evidence of recurrent or residual infection. The study shows that combined with perioperative antibiotic regimen, anterior instrumentation is effective and safe in the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine directly following radical debridement and autogenous bone grafting.

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“…Furthermore, insertion of titanium interbody cage after debridement have gained wide acceptance in the setting of concomitant infection. Recently, several retrospective studies revealed greater improvement in sagittal alignment in patients with titanium cages and in patients with posterior instrumentation than for patients without such instrumentations 7,9,15) .…”

Section: Discussionmentioning

confidence: 99%

Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

Lim

Kim

et al. 2008

J Korean Neurosurg Soc

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Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis*1

Cited by 121 publications

References 21 publications

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

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