Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis

Object. Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the ha rdware. Comparatively fewer patients with pyogenic discitis and vertebral o steomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, a nd internal fixation. The purpose of this study was to determine the effica cy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. Methods. A retrospective analysis of 17 consecutive patients with PDVO trea ted between July 1996 and September 1999 was performed. Follow-up data (mea n 30 months) included office examinations and telephone interviews, and pat ients were grouped according to the duration of preoperative antibiotic the rapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were indepe ndently ambulatory, and three required a walker, only five had been ambulat ing independently preoperatively. Two patients died during the Ist postoper ative week of medical complications; another developed a wound dehiscence t hat was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonst rated on dynamic radiography. Most patients received only a 6-week course o f intravenous antibiotics postoperatively. Conclusions. The authors conclude that single-stage debridement, arthrodesi s, and internal fixation can be effective in the treatment of PDVO. A 6-wee k course of postoperative intravenous antibiotics may be sufficient in pati ents with few risk factors. The harvesting of iliac autograft through the s ame operative exposure may not increase the risk of secondary infection.