Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2007-04, Vol.32 (9), p.E275-E280
• Main Authors: Ruf, Michael, Stoltze, Dieter, Merk, Harry R, Ames, Michael, Harms, Jürgen
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - microbiology; Cervical Vertebrae - surgery; Debridement - methods; Female; Humans; Internal Fixators; Joint Instability - surgery; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - microbiology; Lumbar Vertebrae - surgery; Male; Middle Aged; Osteomyelitis - surgery; Prosthesis Design; Prosthesis Implantation; Radiography; Retrospective Studies; Spinal Diseases - microbiology; Spinal Diseases - surgery; Surgical Mesh; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - microbiology; Thoracic Vertebrae - surgery; Titanium; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000261034.83395.7f

A retrospective clinical and radiologic evaluation of patients with vertebral osteomyelitis treated via radical debridement and stabilization using titanium mesh cages. To assess the efficacy of titanium mesh cages in the treatment of active vertebral osteomyelitis. Although titanium mesh cages have proven to be superior in trauma and tumor reconstructions, there are few reports regarding the use of titanium mesh cages in the presence of active pyogenic or tuberculotic vertebral osteomyelitis. A total of 88 cases with vertebral osteomyelitis were operated on between January 2000 and December 2002. There were 2 craniocervical, 13 cervical, 19 thoracic, 11 thoracolumbar, and 43 lumbar infections. The titanium mesh cages replaced 1 disc in 34 cases, 1 vertebral body in 28 cases, 2 vertebral bodies in 23 cases, and 3 vertebral bodies in 3 cases. All patients showed a solid bony fusion without any recurrence of infection at latest follow-up. Changes in pain score, Frankel's classification, and blood parameters demonstrated a significant clinical improvement in all patients. The sagittal profile was restored. The use of titanium mesh cages in the treatment of vertebral osteomyelitis effectively reconstructs the anterior column, while adding stability and restoring the sagittal profile. There is no increase in the rate of recurrence or persistence of infection related to the implantation of titanium mesh cages.