Pm. Arnold et al., SURGICAL-MANAGEMENT OF NONTUBERCULOUS THORACIC AND LUMBAR VERTEBRAL OSTEOMYELITIS - REPORT OF 33 CASES, Surgical neurology, 47(6), 1997, pp. 551-561
BACKGROUND Thirty-three patients with nontuberculous pyogenic thoracic
and lumbar vertebral osteomyelitis were treated surgically Indication
s for surgery were either progression of disease despite adequate anti
biotic therapy, neurologic deficit, or both. The most common initial s
ymptom was back pain. Seven patients had diabetes, seven patients were
intravenous drug users, two patients were receiving immunosuppressive
therapy, and seven patients had a debilitating disease. Eleven had in
fections elsewhere in their bodies. Prior to surgery organisms were gr
own from blood in 10 patients and at surgery in 15 patients. METHODS I
nfection was evident on plain films in all patients, and either a CT s
can or MRI was obtained in each. The lateral extracavitary approach wa
s used for resection of granulation tissue and infected bone ventral t
o the dura. Interbody bone grafts were placed in 19 patients, usually
when bone resection was extensive. Posterior instrumentation was place
d in 17 patients at a second procedure 10 days-2 weeks following initi
al operation. Intravenous antibiotics were administered for 4-6 weeks
following surgery, and solid fusion was obtained in all patients. RESU
LTS Neurologic deficit was present in 28 patients prior to surgery and
was functionally significant in 18 patients. bf the II patients with
severe paraparesis, 10 achieved good functional recovery. These patien
ts were able to walk, three with assistance and seven without, and all
those who were unable to void regained this ability. CONCLUSIONS Surg
ical debridement, interbody fusion, and posterior instrumentation is a
safe and effective treatment for vertebral osteomyelitis and is indic
ated when neurologic deficit or bone destruction progress despite adeq
uate antibiotic therapy. (C) 1997 by Elsevier Science Inc.