gms | German Medical Science

Objectives: Anterior column reconstruction is a widely accepted treatment option for restoring spinal stability and preventing neurological compromise. Various techniques and implants have been developed for this purpose, including the use of expandable vertebral body replacement (VBR) implants. However, there is limited clinical evidence regarding the effectiveness and safety of these implants in the context of vertebral osteomyelitis. In this study, we aimed to evaluate primary clinical outcome and complications associated with the use of an expandable vertebral body replacement implant for anterior column reconstruction in patients with destructive vertebral osteomyelitis at the thoracolumbar spine.

Methods: A retrospective cohort study of patients who underwent anterior column reconstruction with an expandable vertebral body replacement implant for destructive vertebral osteomyelitis at the thoracolumbar spine between 2003 and 2020 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively after the VBR surgery. Performed surgery, complications, mortality and patient related data was analysed.

Results and conclusion: Forty-five patients (22 female, 23 male; age: 66.2 ± 11.2 years) were included in the study. In twenty-eight patients (62.3%) the infection was found to be in the thoracic spine, and in 5 patients (11.2%) in the thoracolumbar junction. In twelve patients (26.7%) the spondylodiscitis was located in the lumbar spine. Staphylococcus aureus was isolated in intraoperative specimens in 14 cases (31.2%). The etiology was differentiated between healthcare-associated and community-acquired vertebral osteomyelitis (HAVO and CAVO) and we found a homogenous contribution of n=22 HAVO and n=23 CAVO cases. All patients received perioperative antibiotics. Ventro-dorsal stabilization was conducted as a one-staged procedure in 31 cases with a mean surgical duration of 175.1±54.6 minutes. Thirty-four (75.6%) patients were admitted to the intensive care unit during their stay in hospital. The average length of stay on intensive care unit was 7.0±10.1 days. Thirteen patients (28.9%) presented with a septic fulminant course of disease. In seven cases revision surgery was required (15.6%) due to dislocation, loosening of the material or other reasons. The overall mortality was 15.6%.

We found a high complication and mortality rate in the ventro-dorsally treated patient cohort, which may be partially contributable to the frailty of mainly geriatric patients, suffering from spondylodiscitis. Further, prospective studies will be necessary to identify patients that will profit best from VBR and to screen for patients at risk for un-favorable outcomes.