Primary reconstruction for spinal infections

Abstract

<jats:p>Primary reconstruction using bone grafts and instrumentation for spinal infections remains controversial. Between 1991 and 1993, 27 infections of the spinal column were treated at the Department of Neurosurgery of the University of Florida. Of the 27 cases 20 (six cervical, eight thoracic, and six lumbar spine) required surgical debridement and spinal reconstruction to maximize eradication of the infection and maintenance of spinal alignment. All of the cervical and lumbar cases were caused by bacterial infections, and two of eight thoracic cases were caused by tuberculous infections. Spinal arthrodesis was performed in all cases: interbody grafts were used in 18 procedures and posterolateral onlay grafts in 14. Interbody grafts were autologous in 10 cases (six rib and four iliac crest) and homoplastic in eight (six fibular and two humerus). All of the posterolateral onlay grafts were autologous (three rib and 11 iliac crest). Spinal instrumentation was used in 15 cases: four with Caspar plates and 11 with posterior segmental fixation (five hook/rod constructs and six screw/rod constructs). Seventeen of 20 patients achieved improved clinical status postoperatively and 18 of 20 showed radiographic evidence of bone fusion. Antibiotic drugs were administered parenterally for an average of 6 weeks followed by a 3-month course of oral antibiotic medications. Tuberculous infections were treated for 1 year with antibiotic therapy. The average follow-up period was 37 months from surgery and 31 months after completion of treatment with antibiotic drugs. The authors conclude that primary arthrodesis and instrumentation can be performed in acute spinal infections; however, successful management depends on aggressive debridement of infectious foci and prolonged treatment with parenteral antibiotic drugs.</jats:p>

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

“…Moreover, early decompression prevents possible secondary ischemic damage to the spinal cord due to vascular compression. 6,11 The presence of infectious material could, in principle, be a contraindication for bone transplants and instrumentation. 21,[25][26][27]37,43,48 One goal of surgery is to preserve spinal stability.…”

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PINAL infections are uncommon and usually affect the lumbar and thoracic spine. 11,20,43 Many authors have recommended fusion as the best surgical solution, but this is controversial. 3,4,20,40,43 Although antibiotic therapy alone can be successful in the early stage of a spinal infection, the presence of an epidural abscess is generally considered an indication for surgical treatment.

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“…Cervical localization is infrequent but often involves an SEA associated with a high risk of morbidity and death. 2,11,43 In the last 10 years, various case series of SEA that included different localizations and surgical protocols have been published, in which the incidence of cervical localization varied from 3 to 30%. 11,20,43 Many authors have recommended fusion as the best surgical solution, but this is controversial.…”

Monitoring of blood parameters following anterior cervical fusion

“…4,5,22 The initiation of efficient therapy after proper and timely diagnosis is difficult because laboratory tests are unspecific, clinical findings vague, initial radiographic findings inconclusive, and magnetic resonance imaging costly. 2,6,7,12,16,[19][20][21]24 The ESR is often used for postoperative screening purposes, although it is unspecific and dependent on a number of irrelevant factors.…”

“…It was also intended to analyze the impact of covariables such as the extent of surgery and hemodilution, which have been linked to changes in these parameters in previous investigations involving other surgical procedures. 1,2,[4][5][6]12,13,15,19,21,24 …”