Introduction: The best surgical technique for patients with bacterial spinal infections is still matter of debate. Recent publications suggest that titanium implants can be used safely in infectious sites in combination with debridement and antibiotic therapy. The aim of this study was to provide further evidence in support of debridement and instrumentation as a single-stage procedure for spinal osteomyelitis/discitis.
Methods: We retrospectively review patients with spontaneous spondylodiscitis in whom medical therapy failed, and consequently underwent instrumented fusion by the same surgeon (DD). We defined failed medical treatment as progression of the neurological deficit, lack of improvement of the inflamatory markers after 48 hours of an adequate antibiotic therapy or progression to spinal deformity in the follow-up x-rays. In all cases, the following variables were evaluated: sex, age, relevant medical history, neurological compromise measured by the Frankel scale, level operated and operation performed, source of infection, etiologic agent, antibiotic treatment, postoperative complications, inflammatory markers, length of hospitalization, fusion time. Quality of life was measured after at least 12 months of the operation with the EQ5D questionnaire.
Results: 12 patients (5 men and 7 women), ranging in age from 42 to 85 years, with a Frankel score of D in 10 cases, and of E in 2 cases, underwent a single stage debridement and posterior instrumented fusion with titanium pedicle screws and interbody autogenous bone. Preoperative neurological deficits improved in all cases and solid bone fusion was achieved in all 12 patients (100%) at 6 months. The indication for surgery was progressive neurological deficit in the lower limbs in 9 cases, lack of improvement after 48hrs of antibiotic therapy guided by blood culture results in 2 patients and progression to spinal deformity in the remaining one. The mean follow-up period was 60 months (range 12 to 100). In all patients the infection healed after surgery, not requiring a second operation to remove the metal implants. Quality of life assessed with the EQ5-questionnaire showed the following results: mobility (median 1, range 1 to 2), personal care (median 1, range 1 to 1), usual activities (median 1.5, range 1 to 2), pain/discomfort (median 1.5, range 1 to 2), anxiety/depression (median 1, range 1 to 2), visual analog scale for health state (median 67.5, range 30 to 80).
Discussion: These findings support that debridement and instrumented fusion can be performed as a single-stage procedure without an increase in the recurrence rate or morbidity. The outcome has been satisfactory in our patients in terms of rate of fusion and quality of life in the long term follow up.
