Treatment of Pyogenic Vertebral Osteomyelitis With Anterior Debridement and Fusion Followed by Delayed Posterior Spinal Fusion

Abstract

This study demonstrates that anterior surgical debridement with fusion, followed by a period of intravenous antibiotics and delayed instrumented posterior fusion, is highly effective in the treatment of pyogenic osteomyelitis that has failed medical management.

Pyogenic spondylitis in the elderly: a report from Japan with the most aging society

“…However, Asamoto [1] reported that 2 months use of antibiotics after normalization of laboratory data was sufficient, and Kourbeti [9] suggested 6-8 weeks minimum up to 3 months antibiotic treatment. Previously reported incidence of paralysis in patients with pyogenic spondylitis are relatively low: 5.2% [12], 7.1% [3], 8% [8], 9.5% [18], and 18% [13]. The incidence of paralysis was high in our patients aged 65 years or older (26/45, 58%) but was low in patients of less than 65 years of age (10/58, 17%).…”

“…Large differences in the percentages of elderly patients with pyogenic spondylitis are reported in the English literature: 46% (60 years of age or older) [2], 16.5% (61 years of age or older) [12] and 42% (65 years of age or older) [3]. These differences are thought to be partially due to national variations in the percentage of aged people in the population and also due to the year of study.…”

“…In recent years, because of the increasing proportion of elderly people in the population, the occurrence of pyogenic spondylitis among the elderly is no longer a rare phenomenon. Recently reported percentages of elderly patients among total cases of pyogenic spondylitis treated surgically are 42% [3], 46% [5], 39% [11], and 40% [15]. Although details of surgical techniques and their favorable results were well described in these reports, patients who had been treated conservatively were not included.…”

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].…”

Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

“…Several authors have suggested bed rest and prolonged external bracing rather than placing spinal instrumentation 1,12) . Others have advocated a staged instrumented operation with a period of antibiotics therapy after debridement only surgery 4,17,19) . In this study, anterior debridement and decompression, ventral interbody grafting, and anterior or posterior instrumentation for stabilization were performed in order to increase the spinal stability and to maintain spinal alignment for more rapid ambulation.…”