Surgical management of one-stage anterior debridement and fusion for pyogenic osteomyelitis of the lower cervical spine

English Keywords:Pyogenic osteomyelitis  Cervical spine  Fusion  Autograft  Anterior approach  Interfixation

English Abstract:

  【Abstract】 Objective：To investigate the clinical results of surgical management of one-stage anterior debridement and fusion for pyogenic osteomyelitis of the lowercervical spine.Method：A retrospective study of 17 consecutive patients between Junuary 2004 and June 2009 treated surgically due to cervical pyogenic osteomyelitis was performed.There were 14 males and 3 females with the mean age at the time of surgery of 56.5 years（range，42-78）.9 cases presented with fever，6 cases with neurological deficits，while 5 cases with radiculopathy.All 17 cases presented with neck pain.13 cases had presence of epidural purulence，and the other 4 cases had prevertebral abscess combined with general vertebral collapse under preoperative MRI.Intravenous broad-spectrum antibiotics for 7-14 days were used prior to operation.All the patients underwent one-stage anterior debridement，vertebral corpectomy and auto iliac crest bone graft and fusion even in the presence of purulence.Periodic check of WBC，ESR，CRP and A-P and lateral radiographic film and CT scan of cervical spine was performed after operation.All cases underwent MRI at the time of the 12th month after operation.Result：The operation time was 50-150min（mean，110min）.No neurovascular injury was noted.All cases were followed-up for a mean of 20.3 months.Healing of the infection was confirmed in all cases by laboratorial，clinical and radiological tests.13 cases had WBC，ESR，CRP returned to normal in less than 12 weeks after operation；while the other 4 cases had them still abnormal until 9 months after operation.All cases had fever and neck pain relieved completely in less than 1 week after operation.16 cases had bony fusion evidenced under CT scan in less than 12 months，and 1 case developed into pseudarthrosis at the 24th month.Preoperative neurological deficits improved in all cases.6 cases with preoperative incomplete quadriplegia or paraplegia（Frankel C and D） achieved normal function（Frankel E）.5 cases with radiculopathy had symptom relieved completely.No infection recurrence was noted during follow-up.Conclusion：One-stage anterior debridement，vertebral corpectomy and auto iliac crest bone graft and fusion combined with routine and adequate perioperative antibiotic administration is reliable and effective for pyogenic osteomyelitis in cervical spine even in the presence of purulence.