SEQUENTIAL OR SIMULTANEOUS, SAME-DAY ANTERIOR DECOMPRESSION AND POSTERIOR STABILIZATION IN THE MANAGEMENT OF VERTEBRAL OSTEOMYELITIS OF THELUMBAR SPINE

Study Design. A retrospective clinical study of patients with vertebra l osteomyelitis of the lumbar spine necessitating surgical treatment. All patients underwent sequential (same-day) or simultaneous anterior decompression and posterior stabilization of the involved vertebrae. O bjective. To evaluate the efficacy and clinical outcome of sequential or simultaneous anterior and posterior surgical approaches in the mana gement of vertebral osteomyelitis of the lumbar spine. Summary of Back ground Data. Anterior approach alone and staged anterior decompression and posterior stabilization have been advocated as the surgical treat ment methods of choice for patients with vertebral osteomyelitis of th e lumbar spine. The drawbacks of the latter management plan are the ne cessity to use external support or the delayed patient mobilization an d the need for additional anesthesia and surgical trauma. Sequential ( same-day) anterior and posterior approaches are used regularly in the surgical management of scoliosis and other spinal deformities. It woul d appear advantageous to also use the same strategy (i.e., combined sa me-day double approaches) in the management of vertebral osteomyelitis of the lumbar spine. Methods. Ten consecutive patients who had a diag nosis of vertebral osteomyelitis of the lumbar spine underwent combine d (same-day) anterior and posterior approaches either in a sequential or simultaneous manner. Indications for surgery included neurologic de ficit, abscess formation, instability with localized kyphosis formatio n, and failure of nonoperative treatment. Patients were evaluated clin ically and radiographically after surgery. Results. All 10 patients ha d uneventful surgery. Only one patient required a second surgical proc edure because of expulsion of the anterior bone graft and pullout of i nstrumentation. All patients were mobilized within the 2 days immediat ely after surgery. At the mean follow-up examination 30 months after s urgery, all patients had regained their motor function and prior ambul atory status.Conclusions. Patients with lumbar osteomyelitis necessita ting surgery can undergo combined, same-day surgery either in a sequen tial or simultaneous manner. This is a safe and efficient way to contr ol the infection and stabilize the affected segments, allowing for ear ly mobilization of these sick elderly patients.