Limits...
Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

Mazur MD, Ravindra VM, Dailey AT, McEvoy S, Schmidt MH - Front Surg (2015)

Bottom Line: Technical report.We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space.At 2-year follow-up, successful fusion and eradication of the infection were achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.

ABSTRACT

Background: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis.

Purpose: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction.

Study design: Technical report.

Methods: We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment.

Results: At 2-year follow-up, successful fusion and eradication of the infection were achieved.

Conclusion: PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus

Patient 2. A 56-year-old man presented with mechanical low back pain. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L5–S1 with erosion of the endplates and collapse of the disk space. Epidural and prevertebral abscesses were also present. Posterior-only decompression and posterolateral fusion without formal debridement of the L5–S1 disk space was performed. Intraoperative cultures failed to yield a causative organism. Posterior instrumentation included pedicle screws at L4 and S1 with S2AI screws (C,D); poor bone quality precluded instrumentation of L5. Broad-spectrum antibiotics with vancomycin and ceftriaxone were administered for 6 weeks, followed by oral doxycycline suppressive therapy for 2 years. At 2 years, CT demonstrated a solid fusion anteriorly between L5 and S1 (E); bridging bone is also seen between L4 and L5.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4585130&req=5

Figure 2: Patient 2. A 56-year-old man presented with mechanical low back pain. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L5–S1 with erosion of the endplates and collapse of the disk space. Epidural and prevertebral abscesses were also present. Posterior-only decompression and posterolateral fusion without formal debridement of the L5–S1 disk space was performed. Intraoperative cultures failed to yield a causative organism. Posterior instrumentation included pedicle screws at L4 and S1 with S2AI screws (C,D); poor bone quality precluded instrumentation of L5. Broad-spectrum antibiotics with vancomycin and ceftriaxone were administered for 6 weeks, followed by oral doxycycline suppressive therapy for 2 years. At 2 years, CT demonstrated a solid fusion anteriorly between L5 and S1 (E); bridging bone is also seen between L4 and L5.

Mentions: Rigid fixation combined with antibiotics can effectively treat PVDO at the lumbosacral junction without formal debridement of the infected tissues. Only a few reports have described outcomes in patients in whom posterior approaches for PVDO were performed without entering the disk space and without removing the infected bone (1–3). Appropriate antibiotic treatment is mandatory. We have observed good results after obtaining cultures and initiating preoperative targeted antibiotic therapy. Nonetheless, prolonged antimicrobial treatment is required for an optimal long-term outcome (4). Instrumentation may also be necessary to prevent deformity, particularly for PVDO at a mobile segment of the spine, such as the lumbosacral junction. Rigid fixation stabilizes the site to promote bone healing by improving blood flow to the disrupted vertebrae, allowing better penetration of antibiotics to the infected tissues (3, 5). In this report, we describe how pelvic fixation with S2AI screws can bolster construct rigidity to enable fusion in the setting of PVDO even when pedicle screw fixation at L5 cannot be achieved. Two patients have been treated successfully in this manner at our institution, and both achieved a solid fusion with eradication of the infection at 2-year follow-up (Figures 1 and 2).


Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

Mazur MD, Ravindra VM, Dailey AT, McEvoy S, Schmidt MH - Front Surg (2015)

Patient 2. A 56-year-old man presented with mechanical low back pain. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L5–S1 with erosion of the endplates and collapse of the disk space. Epidural and prevertebral abscesses were also present. Posterior-only decompression and posterolateral fusion without formal debridement of the L5–S1 disk space was performed. Intraoperative cultures failed to yield a causative organism. Posterior instrumentation included pedicle screws at L4 and S1 with S2AI screws (C,D); poor bone quality precluded instrumentation of L5. Broad-spectrum antibiotics with vancomycin and ceftriaxone were administered for 6 weeks, followed by oral doxycycline suppressive therapy for 2 years. At 2 years, CT demonstrated a solid fusion anteriorly between L5 and S1 (E); bridging bone is also seen between L4 and L5.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585130&req=5

Figure 2: Patient 2. A 56-year-old man presented with mechanical low back pain. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L5–S1 with erosion of the endplates and collapse of the disk space. Epidural and prevertebral abscesses were also present. Posterior-only decompression and posterolateral fusion without formal debridement of the L5–S1 disk space was performed. Intraoperative cultures failed to yield a causative organism. Posterior instrumentation included pedicle screws at L4 and S1 with S2AI screws (C,D); poor bone quality precluded instrumentation of L5. Broad-spectrum antibiotics with vancomycin and ceftriaxone were administered for 6 weeks, followed by oral doxycycline suppressive therapy for 2 years. At 2 years, CT demonstrated a solid fusion anteriorly between L5 and S1 (E); bridging bone is also seen between L4 and L5.
Mentions: Rigid fixation combined with antibiotics can effectively treat PVDO at the lumbosacral junction without formal debridement of the infected tissues. Only a few reports have described outcomes in patients in whom posterior approaches for PVDO were performed without entering the disk space and without removing the infected bone (1–3). Appropriate antibiotic treatment is mandatory. We have observed good results after obtaining cultures and initiating preoperative targeted antibiotic therapy. Nonetheless, prolonged antimicrobial treatment is required for an optimal long-term outcome (4). Instrumentation may also be necessary to prevent deformity, particularly for PVDO at a mobile segment of the spine, such as the lumbosacral junction. Rigid fixation stabilizes the site to promote bone healing by improving blood flow to the disrupted vertebrae, allowing better penetration of antibiotics to the infected tissues (3, 5). In this report, we describe how pelvic fixation with S2AI screws can bolster construct rigidity to enable fusion in the setting of PVDO even when pedicle screw fixation at L5 cannot be achieved. Two patients have been treated successfully in this manner at our institution, and both achieved a solid fusion with eradication of the infection at 2-year follow-up (Figures 1 and 2).

Bottom Line: Technical report.We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space.At 2-year follow-up, successful fusion and eradication of the infection were achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.

ABSTRACT

Background: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis.

Purpose: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction.

Study design: Technical report.

Methods: We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment.

Results: At 2-year follow-up, successful fusion and eradication of the infection were achieved.

Conclusion: PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus