TREATMENT OF OSTEOMYELITIS OF THE SPINE USING PERCUTANEOUS SUCTION IRRIGATION AND PERCUTANEOUS EXTERNAL SPINAL FIXATION

External skeletal fixation is a well-known tool in the management of i nfection of long bones. However, the application of external skeletal fixation in the treatment of spinal infection has not been previously reported. We have used percutaneous external spinal fixation (PESF) fo r the treatment of osteomyelitis of the spine in 23 patients since 198 1. The treatment consists of percutaneous vertebral biopsy for bacteri ologic diagnosis, installation of a suction/irrigation system into the intervertebral disk space, and posterior stabilization (and reduction if indicated) with an external fixator placed percutaneously. This tr eatment was conceived in 15 patients as definitive treatment. One pati ent died due to pulmonary embolism. In 12 patients, the infection heal ed without further operative treatment. Preoperative kyphosis averaged 15-degrees (range 0-30-degrees). At follow-up, kyphotic deformity als o averaged 15-degrees (range 0-30-degrees). Two patients required ante rior debridement and bone grafting because of progression of bony dest ruction. In eight patients, PESF was performed emergently, followed by planned anterior debridement and interbody grafting. The treatment wa s successful in all patients. All fusions healed. Preoperative kyphosi s averaged 18-degrees (range 0-40-degrees). At followup, kyphotic defo rmity averaged 10-degrees (range 0-22-degrees). Our present indication s are listed below and comprise pyogenic and tuberculous osteomyelitis of the spine localized between T3 and S1. The procedure is an alterna tive to conservative or more invasive operative treatment modalities i n the following conditions: (a) painful lesions of the spine with mini mal bone loss, not amenable to efficient orthotic stabilization (thora cic spine from T3 to T9, lumbosacral junction, elderly patients, or pr esence of deleterious general conditions); (b) osteomyelitis of the sp ine from T3 to S1, when emergency decompression of the spine is mandat ory because of neurologic deterioration due to the kyphotic deformity or to a noncapsulated epidural abscess and anterior decompression is n ot possible emergently; (c) pyogenic osteomyelitis of the spine at L5/ S1, when operative treatment is indicated. In addition, percutaneous i nsertion of external skeletal fixation is indicated in the presence of infected wounds, making internal posterior stabilization unsuitable ( e.g., after open decompression of epidural abscess, postoperative infe ctions).