Abstract
Spinal infections can result in devastating consequences for the patient. Surgery is indicated in certain circumstances. Our institution’s surgical intervention for the treatment of spinal infection was studied. The aim was to identify characteristics helpful for future management. Areas of particular interest were the causative agent, organism identification methods, indications for surgery, materials used for anterior column reconstruction and the ultimate outcome.
A retrospective investigation of all patients receiving surgery for spinal infections between the years of 2004 to 2009 was conducted. All surgical postoperative infections were excluded. Twenty patients were identified in the nominated study period. Twelve males and eight females aged in between 15 to 83 with an average age of 59.4 years. The offending organism was a gram positive in half (50%) of the study group. Staphylococcus aureus was overwhelmingly the representative bacterium (90%). Five cases (25%) were attributed to gram negative organisms while tuberculosis was present in four (20%). No organism was identified in one. Blood cultures identified the causative agent in just over half (55%) of the cases while seven (35%) relied on surgically obtained tissue. Computer tomography guided biopsy was positive in only one case. The most common reason for surgical intervention was a combination of neurological deficit and failing medical management. The second most common reason was in cases with an unidentified organism along with neurological issues. Anterior column reconstruction using cortical strut allograft was performed in four patients while another four received a synthetic spacer device. Two patients had both allograft bone and a spacer device. Only single case of autograft anterior column reconstruction was identified. Two deaths occurred following surgery while all surviving patients with preoperative neurological deficits improved. All surviving patients are currently infection free.
The surgical management of spinal infections can result in advantageous outcomes for the patient, especially in the setting of neurological deterioration or failing medical management. The use of allograft bone and synthetic spacer devices in the midst of infection does not appear to prevent successful organism eradication. The possibility of tuberculosis being the offending bacterium cannot be overlooked.
Correspondence should be addressed to: Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
