Clinical characteristics and treatment strategy of infection following percutaneous vertebral augmentation with polymethylmethacrylate cement

English Keywords:Percutaneous vertebral augmentation  Osteoporotic vertebral fracture  Infecion  Clinical characteristic  Treatment strategy

English Abstract:

  【Abstract】 Objectives: To investigate the clinical characteristics and treatment strategy of surgical site infection following percutaneous vertebral augmentation with polymethylmethacrylate (PMMA) cement. Methods: 7 cases of postoperative spinal infections after percutaneous vertebral augmentation with PMMA cement admitted and treated in Fuzhou Second Hospital between January 2018 and December 2019 were retrospectively reviewed. There were 1 male and 6 females, aged from 64 to 83 (mean, 71.3±6.7 years). All 7 patients were initially diagnosed as symptomatic osteoporotic vertebral fractures and underwent percutaneous vertebral augmentation with bone cement, who were diagnosed with surgical site infections 1-17 months(mean, 6.4±5.8 months) postoperatively. Previous medical records were reviewed and the clinical manifestations, inflammatory parameters, imaging characteristics, pathogen detection results, and treatment methods and outcomes were summarized and analysed. Results: On readmission, all 7 patients had severe back pain. All the patients had normal temperature except one who had low fever. Four cases were combined with neurological injury at the time of diagnosis of infections, and one was classified as American Spinal Injury Association(ASIA) grade C and the other three were of ASIA D. Inflammatory parameters were high in all patients, with ESR of 29-95mm/h(62.7±27.2mm/h) and CRP of 10.04-151.8mg/L(46.9±48.7mg/L). Imaging examinations showed bone resorption around bone cement, bone destruction, and inflammatory signal changes at the surgical site. Pathogens were detected in five cases, including three cases of Mycobacterium tuberculosis infection and two cases of nonspecific bacterial infection. Four patients received surgical treatment, of which, three underwent posterior debridement and bone grafting reconstruction, and the other one was treated with stand-alone posterior pedicle screw fixation and fusion. The follow-up period ranged from 7 to 15 months(mean: 12.3±3.8 months) after the revision operation, and all the four patients recovered from infection. Among them, three combined with neurological injury before surgery were recovered to ASIA E from ASIA D. Two patients who refused surgery and received conservative treatment had restricted activities at the end of follow-up. One case died of pulmonary infection before the planned revision surgery. Conclusions: The surgical site infection following percutaneous vertebral augmentation with bone cement features recurrent severe back pain, elevated inflammatory parameters, and characteristic imaging findings as the main clinical manifestations, which shall be treated with surgery on the basis of standard drug therapy.