Vertebral osteomyelitis: an analysis of 38 surgically treated cases

Matsui, Hisao; Hirano, Naoki; Sakaguchi, Yasumichi

doi:10.1007/s005860050027

Cited by 39 publications

(22 citation statements)

References 14 publications

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“…For decades the gold standard has been an anterior debridement and in-situ fusion [9,10,13,16]. However, an increasing number of studies advocate a combination of posterior stabilisation and anterior debridement and interbody fusion.…”

Section: Discussionmentioning

confidence: 99%

“…The reported techniques of surgical treatment range from anterior debridement and interbody fusion [13], debridement and internal fixation from the posterior approach [17] to combined single-stage or twostage posterior instrumentation with anterior debridement and bone grafting [1,5,7,8,11,14,15,19]. Anterior instrumentation or the use of cages has been anecdotally reported, but there is a critical discussion concerning the role of spinal implants in the presence of infection [4,8,19,21].…”

Section: Introductionmentioning

confidence: 99%

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Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Liljenqvist

Lerner

Bullmann

et al. 2003

European Spine Journal

136

123

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Liljenqvist

Lerner

Bullmann

et al. 2003

European Spine Journal

136

123

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“…Its incidence was estimated to be 1 : 250,000 (1) in one series and 1 : 450,000 in another series (2). However, the overall incidence has increased in recent years because there have been 1) an increased incidence of nosocomial bacteremia from intravascular devices, 2) an aging population, and 3) an increased prevalence of injection drug use (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Pyogenic Vertebral Osteomyelitis

et al. 2007

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Objective Early diagnosis of pyogenic vertebral osteomyelitis (PVO) is frequently difficult. There are, however, few studies that have investigated the diagnostic performance of PVO in Japan. Our aim was to analyze the diagnostic performance and identify clinical factors associated with the diagnostic delay of PVO. Materials and Methods We performed hospital-based retrospective case analysis. All patients with PVO were identified from the computerized medical database at Okinawa Chubu Hospital in Okinawa, Japan, from January 1985 to December 2004. We collected the following data; baseline information; laboratory tests; clinical and microbiologic outcomes; and diagnostic process. We used multivariable-adjusted linear regression to identify significant factors associated with patient and hospital delay to the diagnosis of PVO. Results We reviewed total of 209,428 patients hospitalized during the 20-year study period. Of those, we identified 51 patients with PVO. Eighty percent of these patients were misdiagnosed at their initial clinical encounters. Median duration from the symptom onset to the diagnosis was 19 days. Median durations of patient factor and hospital factor that contributed to the total delay were 1 and 8 days, respectively. Significant patient factor that contributed to delay was cognitive dysfunction. Conclusions Cognitive dysfunction is a risk factor for patient delay for visiting physicians in patients with PVO. Diagnosis of PVO is difficult at the initial clinical encounter. High index of suspicion is needed for more rapid diagnosis of PVO.

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“…The surgical techniques range from anterior debridement and interbody fusion [1,2,5,[14][15][16][17], posterior debridement with internal fixation [6] to combined single-session or sequential procedures with posterior instrumentation, anterior debridement, and anterior column reconstruction using autologous bone grafts [3, 4, 7-10, 13, 18-23]. Anterior instrumentation in the presence of infection has been reported [21,24,25] but still remains controversial due to the risk of bacterial adherence and biofilm formation on foreign bodies leading to persistent or recurrent infection [4,[26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Anterior Column Reconstruction Using Titanium Ring Cages in Severe Vertebral Osteomyelitis

Lerner

Schulte²,

Bullmann³

et al. 2006

Eur J Trauma

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Background and Purpose: The use of instrumentation in spinal infections is still a controversial issue. The aim of the present study was to evaluate the efficiency of titanium cages in the surgical treatment of severe vertebral osteomyelitis (synonym spondylodiscitis) concerning eradication of the infection as well as biomechanical aspects. Materials and Methods:The peri-and postoperative data of 43 consecutive patients with vertebral osteomyelitis who underwent single-stage posterior stabilization, anterior debridement including decompression, and anterior column reconstruction using modular titanium ring cages filled with autologous bone were analyzed retrospectively. In 29 cases, a clinical and radiological follow-up of on average 2.5 years (median 2.2 years) was available. To assess the course of spinal alignment, a detailed radiometric analysis was performed. Results: The time of symptoms prior to surgery averaged 4.6 months. Preoperatively, 37% of the patients showed neurologic compromise with partial or complete recovery in 88% after surgery. In 25 patients (58%), a germ was isolated with Staphylococcus aureus being the most frequent pathogen (44%). Except for one patient with anterior revision and exchange of the cage for persistent infection, primary eradication of the infection was accomplished in all patients. At follow-up, all infections were eradicated, and all cages appeared radiographically fused. The present loss of correction in the sagittal plane amounted 1.5° at the affected segment(s) reconstructed by cage interposition and 4.4° at posterior fusion levels. Conclusion:Single-stage posterior instrumentation and fusion combined with anterior debridement and anterior column reconstruction using modular titanium ring cages represent a safe and efficient strategy in cases of severe vertebral osteomyelitis necessitating surgery. The use of titanium cages guarantees longterm maintenance of correction without increased risk of persistent or recurrent infection.

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Vertebral osteomyelitis: an analysis of 38 surgically treated cases

Cited by 39 publications

References 14 publications

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Diagnostic Performance of Pyogenic Vertebral Osteomyelitis

Anterior Column Reconstruction Using Titanium Ring Cages in Severe Vertebral Osteomyelitis

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