BENEFICIAL INFLUENCE OF TITANIUM MESH CAGE ON INFECTION HEALING IN PATIENTS WITH PERSISTENT SEPTIC SPONDYLITIS

Abstract

Several methods of surgical treatment for pyogenic spondylitis have been reported including anterior approach, staged and simultaneous anterior decompression and posterior stabilisation. The use of anterior implants in the presence of infection presents still a challenge for spine surgeons.

Retrospective analysis of the clinical and radiological outcome of patients suffering from pyogenic spondylitis of the cervical and lumbar spine necessitating surgical treatment for intractable pain, instability and neurologic impairment.

Seventeen patients with spondylitis associated or not with paravertebral abscess were treated by one stage surgery (first: anterior decompression and placement of titanium mesh cage, filled with autologous iliac bone graft; second: posterior transpedicular instrumentation and fusion). The age of the patients was 54 ±15 years. Most of the patients had systematic problems such as lung tuberculosis, hepatic cirrhosis, diabetes mellitus or chronic renal failure. Patients were evaluated before and after surgery in terms of pain and neurological level, sagittal spinal balance and radiological fusion. All 17 patients were followed for 45 months.

Average duration of both surgeries was 4.5 hours. The VAS score improved from 7 (preoperatively) to 2 (postoperatively). The correction of the segmental kyphotic deformity was 6o, without loss of correction or cage migration or instrumentation failure. All patients with incomplete neurologic impairment improved postoperatively. There was neither migration of mesh cage nor posterior instrumentation failure at the follow up observation. There was an approach-related abdominal hernia.

This clinical study showed that patients with cervical and thoracolumbar osteomyelitis necessitating surgery for certain indications can successfully undergo instrumented combined, one-stage, same-day surgery. The presence of the mesh cage anteriorly at the site of infection had not negative but beneficial influence on the course of infection healing, and it additionally stabilised the affected segment, maintaining sufficient sagittal profile.