Abstract
Aim
Infection after vertebroplasty (VP) is a rare but serious complication. Previous literatures showed most pathogens for infection after VP were bacteria; tuberculosis (TB) induced infection after VP was extremely rare. In this study, we reported our treatment experiences of 18 cases with infectious spondylitis after VP, and compared the differences between developed pyogenic and TB spondylitis.
Method
From January 2001 to December 2015, 5749 patients underwent VP at our department were reviewed retrospectively. The causative organisms were obtained from tissue culture of revision surgery. Parameters including type of surgery, the interval between VP and revision surgery, neurologic status, and visual analog scale of back pain were recorded. Laboratory data at the time of VP and revision surgery were collected. Risk factors including the Charlson comorbidity index (CCI), preoperative bacteremia, urinary tract infection (UTI), pulmonary TB history were also analyzed.
Results
18 patients developed infectious spondylitis after VP (0.32%, 18/5749). Two were male and 16 were female. The median age at the time of VP was 73.4 years. The mean CCI score was 1.7. The causative organisms were TB in nine patients (Fig. 1), and bacteria in nine patients (Fig. 2). The interval between VP and revision surgery ranged from 7 to 1140 days (mean 123.2 days). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated in most patients especially at readmission. The most common type of revision surgery was anterior combined posterior surgery. Seven patients developed neurologic deficit before revision surgery. Three patients died within 6 months after revision surgery, with a mortality of 16.7%. Finally, VAS of back pain was improved from 7.4 to 3.1. 7 patients could walk normally, 5 patients needed walker support, 3 patients depended on wheelchair for ambulation (Table 1). Both pyogenic and TB group had similar age, sex, and CCI distribution.
The interval between VP and revision surgery was shorter in the patients with pyogenic organisms (75.9 vs 170.6 days). At revision surgery, WBC and CRP were prominently elevated in the pyogenic group. Five in the pyogenic group had UTI or bacteremia; five in TB group had a history of lung TB (Table 2).
Conclusions
VP is a minimal procedure but sustains possibility of postoperative infection, which required major surgery for salvage with a relevant part of residual disability. Before surgery, any bacteremia/ UTI or history of pulmonary TB should be reviewed rigorously; any elevation of infection parameters should be scrutinized strictly.
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