Artikel
Debridement and spinal instrumentation in pyogenic spondylitis
Débridement und instrumentierte Spondylodese bei eitriger Spondylitis
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Controversy exists on the use of instrumentation in an infected site (e.g. pyogenic spondylitis). Recent Publications suggest that titanium implants can be safely used in infectious or contaminated sites in combination with debridement and antibiotic therapy. The aim of the study was to evaluate the clinical outcome of patients treated with surgical debridement and titanium instrumentation for pyogenic spondylitis.
Methods
Eighteen (18) patients (8 female, 10male) with pyogenic (n=14), tuberculotic (n=2) and post infectious (n=2) spondylitis were included in this study. The Cervical (n=4), thoracic (n=12) and lumbar (n=2) spine were affected. Every patient had a debridement followed by titanium instrumentation. The procedure was performed by an anterior or anterolateral (n=13), posterior (n=3) or combined anterior and posterior approach (n=2). The mean age at the time of surgery was 65y (range: 22 to 78). The majority of patients had risk factors, such as Diabetes, renal failure, infiltrations, trauma or prior surgery. Patients were evaluated before and after surgery in terms of pain level, neurologic status, Barthel index, radiologic and hematologic parameters. The mean follow-up period was 10 months (range: 3 to 25).
Results
There was an average decrease of 1-2 points in the Pain scale of Denis. Blood parameters showed significant decrease (mean Leukocyte count decreased from 11,4/nl to 7,1/nl and mean CRP levels dropped from 67mg/l to 9mg/l). Barthel index and sagittal angle in radiological evaluation were improved. Wound infection occurred in 3 patients. None of the instrumentations had to be removed.
Conclusions
This single stage approach for spondylitis provided satisfactory results also in patients with poor clinical condition and acute spondylitis.