Efficacy of circumferential surgery for multisegmental pyogenic cervical spine infection

To evaluate the efficacy of circumferential surgery, involving combined anterior and posterior approaches, in the management of multisegmental cervical pyogenic spondylitis (CPS).

A retrospective analysis was conducted on 12 patients with multisegmental CPS who underwent circumferential surgical intervention between January 2015 and November 2023. The study evaluated medical records, spinal alignment correction, postoperative complications, and neurological functional recovery.

In total, 12 patients (8 men and 4 women; mean age: 57.1 years) met the inclusion criteria. Identified risk factors included diabetes mellitus in four patients, a history of substance abuse in two patients, and long-term immunosuppressive therapy following organ transplantation in one patient. Preoperatively, nine patients presented with spinal cord or nerve root compression. All patients underwent circumferential surgery with anterior column reconstruction using autologous bone grafts; titanium alloy plates were additionally used in two cases. Posterior stabilization was achieved using pedicle screws or lateral mass screws. The mean number of corpectomies performed was 3.7 (range, 3-5); the mean number of fused levels was 4.8 (range, 4-7). The mean follow-up duration was 19.4 (range, 6-38) months. Cervical alignment improved significantly, with the mean C2-7 Cobb angle changing from - 5° preoperatively to 3° postoperatively. Neurological function significantly improved in all patients (P = 0.023), and successful bone fusion was achieved in 11 patients (91.7%) at the final follow-up. Pathogens were identified in seven cases, including Staphylococcus aureus Staphylococcus epidermidis (n = 2), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). All patients received intravenous antibiotic therapy for 4-6 weeks postoperatively, followed by oral antibiotic treatment for an additional 6-8 weeks. No intraoperative complications were reported. Postoperatively, one patient developed pneumonia with respiratory failure, and another experienced posterior cervical wound infection.

Circumferential surgical intervention combined with appropriate antibiotic therapy appears to be an effective treatment strategy for achieving satisfactory outcomes in patients with multisegmental CPS.