Surgical outcomes of infectious spondylitis after vertebroplasty, and comparisons between pyogenic and tuberculosis
Jen-Chung Liao1, Po-Liang Lai2, Lih-Hui Chen2
1Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fu-Shin Street Kweishian, Taoyuan, 333, Taiwan. jcl1265@adm.cgmh.org.tw.
Background:
Infection after vertebroplasty (VP) is a rare but serious complication. Previous literatures showed most pathogens for infection after VP were bacteria; tuberculosis (TB) induced infection after VP was extremely rare. We reported our treatment experiences of cases with infectious spondylitis after VP, and compared the differences between developed pyogenic and TB spondylitis.
Methods:
From January 2001 to December 2015, 5749 patients had undergone VP at our department were reviewed retrospectively. The causative organisms were obtained from tissue culture of revision surgery. Parameters including type of surgery, the interval between VP and revision surgery, neurologic status, and visual analog scale (VAS) of back pain were recorded. Laboratory data at the time of VP and revision surgery were collected. Charlson comorbidity index (CCI), preoperative bacteremia, urinary tract infection (UTI), pulmonary TB history were also analyzed.
Results:
Eighteen patients were confirmed with developed infectious spondylitis after VP (0.32%, 18/5749). Two were male and 16 were female. The median age at VP was 73.4 years. Nine patients were TB and the other nine patients were pyogenic. The interval between VP and revision surgery ranged from 7 to 1140 days (mean 123.2 days). The most common type of revision surgery was anterior combined with posterior surgery. Seven patients developed neurologic deficit before revision surgery. Three patients died within 6 months after revision surgery, with a mortality of 16.7%. Finally, VAS of back pain was improved from 7.4 to 3.1. Seven patients could walk normally, the other 8 patients had some degree of disability. Both pyogenic and TB group had similar age, sex, and CCI distribution. The interval between VP and revision surgery was shorter in the patients with pyogenic organisms (75.9 vs 170.6 days). At revision surgery, WBC and CRP were prominently elevated in the pyogenic group. Five in the pyogenic group had UTI and bacteremia; five in TB group had a history of lung TB.
Conclusions:
Infection spondylitis after VP required major surgery for salvage with a relevant part of residual disability. Before VP, any bacteremia/UTI or history of pulmonary TB should be reviewed rigorously; any elevation of infection parameters should be scrutinized strictly.
Insights
Infection after vertebroplasty (VP) is rare but serious. This study compared pyogenic and tuberculosis (TB) infections post-VP, finding TB infections had a longer interval to diagnosis and treatment than pyogenic ones.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Spinal Surgery
Background:
- Vertebroplasty (VP) can lead to rare but severe infections.
- While bacterial infections are common, tuberculosis (TB) is an extremely rare cause of post-VP infection.
- This study details treatment experiences and compares pyogenic and TB spondylitis after VP.
Purpose of the Study:
- To report treatment experiences for infectious spondylitis following vertebroplasty (VP).
- To compare the clinical characteristics and outcomes of pyogenic versus TB spondylitis after VP.
Main Methods:
- Retrospective review of 5749 patients undergoing VP from 2001-2015.
- Causative organisms identified via tissue culture during revision surgery.
- Analysis of patient demographics, surgical details, clinical status, laboratory data, and comorbidities.
Main Results:
- Eighteen patients (0.32%) developed infectious spondylitis post-VP; nine were TB and nine were pyogenic.
- TB infections had a longer interval between VP and revision surgery (170.6 days) compared to pyogenic infections (75.9 days).
- Pyogenic infections showed higher WBC and CRP levels, and were associated with UTI and bacteremia; TB infections were linked to a history of pulmonary TB.
Conclusions:
- Infectious spondylitis post-VP necessitates major surgery and can result in residual disability.
- Rigorous pre-VP screening for bacteremia, UTI, and pulmonary TB history is crucial.
- Close monitoring for elevated infection parameters is essential to detect post-VP infections early.
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