SURGICAL-MANAGEMENT OF NONTUBERCULOUS THORACIC AND LUMBAR VERTEBRAL OSTEOMYELITIS - REPORT OF 33 CASES

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.