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Overview and classification of spinal infections
1Division of Neurotrauma, Rancho Los Amigos Medical Center, Downey, California, USA.
The Orthopedic Clinics of North America
|January 1, 1996
Summary
Hematogenous vertebral osteomyelitis, often caused by S. aureus, requires surgical intervention when antibiotics fail, especially with deformity or neurologic compromise. Treatment varies based on infection location, with anterior or posterior approaches and fixation strategies tailored to the specific case.
Area of Science:
- Spinal surgery
- Infectious diseases
- Orthopedic surgery
Background:
- Hematogenous spread is the primary cause of vertebral osteomyelitis.
- Staphylococcus aureus is the most frequent pathogen in pyogenic vertebral osteomyelitis.
- Diabetics and intravenous drug abusers are at higher risk for hematogenous osteomyelitis, while tuberculous spondylitis is prevalent globally.
Purpose of the Study:
- To review the common causes and pathogens of vertebral osteomyelitis.
- To outline surgical indications and approaches for vertebral body infections.
- To discuss management strategies for spinal epidural abscesses and the controversial use of spinal fixation.
Main Methods:
- Review of existing literature on vertebral osteomyelitis and spinal infections.
- Analysis of treatment strategies based on infection location (anterior vs. posterior).
- Discussion of surgical techniques including debridement, strut grafting, and spinal fixation.
Main Results:
- Vertebral body infections unresponsive to antibiotics, or those causing significant deformity or neurologic compromise, necessitate anterior debridement with strut grafting.
- Posterior infections, typically post-surgical, require posterior irrigation and debridement.
- Spinal epidural abscesses with neurologic symptoms demand antibiotics and surgical debridement, usually via a posterior approach unless anterior involvement is present.
Conclusions:
- Surgical management of vertebral osteomyelitis is guided by infection location, severity, and response to antibiotics.
- Anterior approaches are used for vertebral body infections, while posterior approaches are standard for posterior or epidural infections.
- The use of spinal instrumentation in infected sites is controversial but may be required in select cases, with posterior fixation often preferred for anterior infections.