Safety and efficacy of polyetheretherketone (PEEK) cages in combination with posterior pedicel screw fixation in pyogenic spinal infection

Shiban, Ehab; Janssen, Insa; Cunha, Paulo Rupino da; Rainer, Jessica; Stoffel, Michael; Lehmberg, Jens; Ringel, Florian; Meyer, Bernhard

doi:10.1007/s00701-016-2924-z

Cited by 36 publications

(33 citation statements)

References 30 publications

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“…Recently, many independent studies have shown that instrumented spine surgery for spinal infections is a safe and feasible option. 2,3,[5][6][7][8][9][12][13][14][15] Conversely, spinal stabilization could even promote accelerated healing. 9 The risk of reoperation for infection in patients with instrumentation for spinal infection is ≤ 10%.…”

Section: Discussionmentioning

confidence: 99%

Single-approach vertebral osteosynthesis in the treatment of spinal osteolysis by spondylodiscitis

Rustemi¹,

Raneri²,

Alvaro³

et al. 2019

Neurosurgical Focus

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OBJECTIVEBoth spontaneous and iatrogenic spondylodiscitis are becoming ever more frequent, yet there are no definite treatment guidelines. For many years the treatment protocol was conservative medical management or surgical debridement with patients immobilized or bedridden for weeks and often resulting in spinal deformity. The eventual development of spinal deformity can be difficult to treat. Over the last few years, the authors have preferred a single-approach instrumented arthrodesis when spondylolysis that evolves in deformity from somatic wedging occurs.METHODSThe authors retrospectively reviewed the clinical, radiological, and surgical records of 11 patients treated over the past 3 years for spondylodiscitis with osteosynthesis.RESULTSOverall, the authors treated 11 patients: 3 cases with tuberculous spondylodiscitis (1 dorsal, 2 lumbar); 6 cases with Staphylococcus aureus spondylodiscitis (1 cervical, 2 dorsal, 2 lumbar, 1 dorsolumbar); 1 spondylodiscitis with postsurgical lumbar deformity; and in 1 dorsolumbar case the germ was not identified. Surgical approaches were chosen according to spinal level: In 8 dorsolumbar cases a posterior osteosynthesis was achieved. In 1 cervical case an anterior approach was performed with autologous bone graft from iliac crest. In 2 thoracolumbar cases a posterolateral costotransversectomy was needed. In 1 lumbosacral case iliac somatic grafting was used. Ten patients received adequate antibiotic treatment with clinical remission, and 1 case is in initial follow-up. No complications due to instrumentation were recorded. Spinal deformity was prevented in 10 cases, whereas preexisting spinal deformity was partially corrected in 1 case. In all cases, arthrodesis achieved vertebral stability.CONCLUSIONSThis study has the limitations of a retrospective review with a limited number of patients. Instrumentation does not appear to hamper healing from infection. Moreover, spinal stabilization, which is assisted by the infectious process even in the absence of bone graft, allows early mobilization. Instrumented osteosynthesis should be preferred for spondylodiscitis with osteolysis and spinal instability because it allows early mobilization and rehabilitation whenever necessary. It prevents spinal deformity and does not hamper healing of infections.

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Section: Discussionmentioning

confidence: 99%

Single-approach vertebral osteosynthesis in the treatment of spinal osteolysis by spondylodiscitis

Rustemi¹,

Raneri²,

Alvaro³

et al. 2019

Neurosurgical Focus

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“…The use of metallic interbody cages is not the sole possibility to perform a single-stage procedure without the additional morbidity of an autologous graft. Allografts have also been proposed for patients with poor general condition (52) and the use of PEEK was presented in several publications with satisfying results (12,61,69,72,73). The latter has however been recently associated to allergic reactions which deserve further safety investigation (74,75).…”

Section: Discussionmentioning

confidence: 99%

Treatment of infections of the lumbar spine with single-staged posterior instrumentation, disc debridement and interbody fusion with titanium cages

Cucchi

Deharde

Kasapovic

et al. 2019

Muscle Ligaments and Tendons J

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Background. The goal of this study is to compare the clinical and radiological results of a singlestaged posterior instrumentation, disc debridement and interbody fusion with titanium cages for patients with pyogenic infections of the lumbar spine and patients with degenerative disc disease. Methods. Posterior instrumentation, disc debridement and interbody fusion with titanium cages was performed on 35 patients affected by infections of the lumbar spine with compression of neural elements, neurological deficits or abscesses. At a minimum follow-up of one year, a functional and radiological evaluation was conducted, including a CT-scan of the operated segments to assess bony interbody fusion. A matched series of patients who underwent 360°-fusion with titanium interbody cages for the treatment of single-level degenerative disc disease was used as control group. Results. Twenty-eight patients were available for evaluation. The median VAS improved notably after intervention, as did the questionnaires investigating function, activities of daily living and quality of life. These changes were comparable to those observed in the control group. A similar proportion of patients rated the results of surgical intervention as good or excellent in both groups. Bony interbody fusion was observed in 87.5% of the patients. Conclusion. Posterior instrumentation, disc debridement and interbody fusion with titanium cages can effectively reduce pain and leads to an acceptable fusion rate. A substantial equivalence in terms of clinical results and subjective satisfaction is obtained in patients receiving this surgery for pyogenic infections with minimal anterior column disruption and for the treatment of degenerative disc disease.

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“…In our case, surgical intervention for evacuation of pus via anterior approach and corpectomy of the C4 and C5, iliac crest graft with plate and screws fixation was done [11][12][13][14]. Many are believed nowadays that the cervical epidural abscesses are best managed with bony decompression followed by internal stabilization in purulent osteomyelitis and usually by anterior fusion [5,12,15].…”

Section: Discussionmentioning

confidence: 99%

“…While the need for instrumental stabilization remains questionable when predominant problem is the abscess. In 2016, Shiban et al [11] reported the safety of instrumentation devices of fixation in patients suffering from pyogenic spinal infections [11].…”

Section: Discussionmentioning

confidence: 99%

Extensive Cervical Epidural Abscess: Case Report

Elsebaey¹

2017

JNSK

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Safety and efficacy of polyetheretherketone (PEEK) cages in combination with posterior pedicel screw fixation in pyogenic spinal infection

Abstract: Use of PEEK cages for interbody fusion is feasible and safe in patients suffering from a pyogenic spinal infection.

Cited by 36 publications

References 30 publications

Single-approach vertebral osteosynthesis in the treatment of spinal osteolysis by spondylodiscitis

Single-approach vertebral osteosynthesis in the treatment of spinal osteolysis by spondylodiscitis

Treatment of infections of the lumbar spine with single-staged posterior instrumentation, disc debridement and interbody fusion with titanium cages

Extensive Cervical Epidural Abscess: Case Report

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