External fixation of the spine: surgical salvage option for complex spinal infections

The use of external fixation has been described for various conditions but has never become a popular technique in spine surgery. The objective of this study is to describe the successful application of external fixation of the spine in three cases of complex spine infection. The first case is a 51-year-old male with T2-T3 spinal osteomyelitis secondary to Actinomyces lung infection causing epidural abscess and signs of cord compression. Laminectomy and debridement of the epidural abscess was performed, and external fixation was applied percutaneously spanning C7-T5. The second case is an 18-year-old soldier with a gunshot wound to the abdominal cavity with small bowel perforation and fracture of L1 and L2. Retroperitoneal infection developed at this level and was drained percutaneously. External fixation of T10-L4 was performed. The third case is a 60-year-old male who underwent resection of a locally invasive lung tumor at T3. Postoperative CSF leak and widespread infection was noted, mandating debridement and removal of the infected hardware. External fixation of T1-T8 was applied for temporary stabilization. All patients tolerated the procedure well, and rapid ambulation and physical therapy was initiated. Under broad-spectrum antibiotic therapy, resolution of infection was noted in all three cases as well as good sagittal and coronal axis alignment on follow-up imaging. We conclude that external fixation of the spine is a safe and effective surgical technique that can be considered as salvage treatment for spinal infections accompanied by segmental spinal instability.