Vertebral osteomyelitis. The surgical management of neurologic complications

Twelve patients with neurologic complications of vertebral osteomyelitis are reported. Initial symptoms were due to diffuse intraspinal abscesses (epidural or subdural) in six patients and to kyphotic deformities in three. A localized anterior subligamentous abscess was found in one patient and a similar abscess with kyphosis in one. Kyphosis and diffuse epidural abscess were found in one patient. Operations were designed to relieve cord compression and maintain or improve spinal stability. Outcome was good in eight patients and poor in two; two patients died. Delayed neurologic deterioration after laminectomy occurred in two patients who presented with epidural abscess and minimal signs of osteomyelitis due to subsequent development of anterior abscess and spinal deformity. Therapy of this problem is discussed, with emphasis on choice of technique for neural decompression. Adequate decompression with attention to stability will yield a good result in the majority of cases.