B. Jeanneret et F. Magerl, TREATMENT OF OSTEOMYELITIS OF THE SPINE USING PERCUTANEOUS SUCTION IRRIGATION AND PERCUTANEOUS EXTERNAL SPINAL FIXATION, Journal of spinal disorders, 7(3), 1994, pp. 185-205
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).