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  • Title: [Osteomyelitis of the spine and its surgical treatment--personal experience].
    Author: Vrzala J, Pilát P, Vrzala J, Teyssler P.
    Journal: Acta Chir Orthop Traumatol Cech; 2001; 68(6):380-3. PubMed ID: 11847931.
    Abstract:
    PURPOSE OF THE STUDY: Evaluation of surgical treatment of osteomyelitis of the spine, determination of efficient diagnostic and therapeutic criteria. MATERIAL: The examined group comprised in total 27 patients. No selection was made, all patients who were operated on and treated at the Department of the authors were followed gradually as they were admitted at the Department. METHODS: Evaluation was based on the monitoring of the clinical condition of patients including laboratory tests. Evaluated was also the achievement of vertebral body fusion three months after the surgery. The surgical procedure always contained a radical debridement of inflammatory focus, a massive autogenous cancellous bone grafting mixed with Gentamycin foam, either separately or in combination with instrumentation. Approach to the inflammatory focus was in 9 cases transforaminal posterior, in 2 cases transforaminal combined with transversectomy, in 2 cases transforaminal combined with laminectomy, in 4 cases transthoracic, in 1 case transabdominal, in 7 cases retroperitoneal and once percutaneous technique was used. RESULTS: All patients operated on healed without complications. Local pain and temperature subsided rapidly (in terms of days). Also objective inflammatory criteria returned to normal (in terms of weeks). Seven patients show improved neurological status. X-ray examination 3 months after the surgery always shows consolidation and ingrowth of cancellous bone grafts without local relapse or loss of correction. DISCUSSION: The numbers of patients of the authors' group correspond with the numbers of patients presented in literature. There is also agreement with other authors that a modern treatment of spinal osteomyelitis should include a radical debridement of the focus combined with instrumentation, neurological decompression and application of cancellous bone grafts completed by local antibiotics. As compared to other authors who present a prevalence of abscess the histological examination of our cases shows predominantly inflammatory granuloma. CONCLUSION: Radical surgical treatment of spinal osteomyelitis including debridement, cancellous bone grafting, internal fixation (instrumentation) and decompression together with a general treatment and orthotic management seems to be an efficient way of the treatment of this serious disease.
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