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Surgical strategies for vertebral osteomyelitis and epidural abscess
Patrick C Hsieh1, Robert J Wienecke, Brian A O'Shaughnessy
1Department of Neurological Surgery, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois 60611, USA.
Abstract:
Pyogenic vertebral discitis and osteomyelitis (PVDO) has become an increasing problem for the spine surgeon. Despite recent advances in medical care and improved diagnostic neuroimaging, PVDO remains a major cause of illness and death in the elderly population. Infection of the spinal column often presents insidiously; however, if not treated appropriately and in a timely manner it can lead to severe neurological impairment, systemic septicemia, and progressive spinal deformity. In this paper the authors review the epidemiological and pathophysiological features and the clinical presentation of PVDO. Conventional medical therapy is described, with a particular focus on the methods of diagnosis. Surgical strategies for PVDO are then presented based on the literature and according to the practice of the senior author (S.L.O.), with an emphasis placed on structural considerations, implant selection, and techniques for augmenting vascular tissue to the site of infection.
Insights
Pyogenic vertebral discitis and osteomyelitis (PVDO) is a growing concern in elderly patients. Early diagnosis and appropriate treatment, including surgical strategies, are crucial to prevent severe complications.
Area of Science:
- Spine surgery
- Infectious diseases
- Orthopedics
Background:
- Pyogenic vertebral discitis and osteomyelitis (PVDO) is an increasing cause of morbidity and mortality, particularly in the elderly.
- Spinal infections can present insidiously, leading to severe neurological deficits, sepsis, and deformity if not managed promptly.
Purpose of the Study:
- To review the epidemiology, pathophysiology, and clinical presentation of PVDO.
- To discuss conventional medical and surgical management strategies for PVDO.
Main Methods:
- Literature review of epidemiological and pathophysiological features.
- Analysis of clinical presentation and diagnostic methods.
- Presentation of surgical strategies based on existing literature and senior author's practice.
Main Results:
- PVDO poses significant challenges despite advances in diagnostics and medical care.
- Timely and appropriate treatment is essential to avert severe patient outcomes.
- Surgical interventions require careful consideration of structural integrity, implant choice, and vascularized tissue augmentation.
Conclusions:
- PVDO necessitates a comprehensive understanding of its multifaceted nature.
- Effective management hinges on accurate diagnosis and tailored therapeutic approaches, encompassing both medical and surgical interventions.
- Surgical techniques should prioritize spinal stability and infection eradication.
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