Osteomyelitis-Discitis at the Thoracolumbar Junction and the Development of Postinfectious Spinal Deformity: A Surgical Case Series.
osteomyelitis
spinal deformity
spine fusion
thoraco-lumbar junction
Journal
International journal of spine surgery
ISSN: 2211-4599
Titre abrégé: Int J Spine Surg
Pays: Netherlands
ID NLM: 101579005
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
entrez:
28
9
2020
pubmed:
29
9
2020
medline:
29
9
2020
Statut:
ppublish
Résumé
Progressive spinal deformity and neural compromise are the main indications for surgical management of vertebral osteomyelitis-discitis. However, when such pathology presents at the thoracolumbar (TL) junction, it remains unclear what the appropriate intervention is. The therapeutic dilemmas of decompression with or without instrumented fusion, the need for circumferential decompression and reconstruction, as well as the prognostic factors for progression of kyphosis, all remained ill-defined in the literature. The objective of this study is to evaluate risk factors for instrumentation at TL junction in spinal osteomyelitis-discitis. A review of patients at a single center with osteomyelitis-discitis at the TL junction between 2014 and 2018 was performed. Patients were 18 years or older with infectious pathologies at T10 to L2. Sixteen patients were included. Indication for instrumentation included progression of kyphosis following prior laminectomy/medical management. Of the 16 patients, 4 patients received laminectomy at initial treatment versus 12 patients receiving medical management alone. All 4 patients receiving laminectomy experienced progressive kyphosis requiring revision with instrumented fusion versus only 4 of 12 of the medically managed. Laminectomy, epidural compression, and vertebral body collapse were significant risk factors for kyphosis progression requiring instrumentation. The average time to surgical intervention for the indication of progressive kyphosis was 2.6 months after prior laminectomy and 6 months after initiation of medical management. Given the proclivity for kyphotic deformity at the TL junction, patients may benefit from long segment instrumentation in addition to decompression at the initial surgery. Laminectomy alone may hasten kyphosis progression.
Sections du résumé
BACKGROUND
BACKGROUND
Progressive spinal deformity and neural compromise are the main indications for surgical management of vertebral osteomyelitis-discitis. However, when such pathology presents at the thoracolumbar (TL) junction, it remains unclear what the appropriate intervention is. The therapeutic dilemmas of decompression with or without instrumented fusion, the need for circumferential decompression and reconstruction, as well as the prognostic factors for progression of kyphosis, all remained ill-defined in the literature. The objective of this study is to evaluate risk factors for instrumentation at TL junction in spinal osteomyelitis-discitis.
METHODS
METHODS
A review of patients at a single center with osteomyelitis-discitis at the TL junction between 2014 and 2018 was performed. Patients were 18 years or older with infectious pathologies at T10 to L2.
RESULTS
RESULTS
Sixteen patients were included. Indication for instrumentation included progression of kyphosis following prior laminectomy/medical management. Of the 16 patients, 4 patients received laminectomy at initial treatment versus 12 patients receiving medical management alone. All 4 patients receiving laminectomy experienced progressive kyphosis requiring revision with instrumented fusion versus only 4 of 12 of the medically managed. Laminectomy, epidural compression, and vertebral body collapse were significant risk factors for kyphosis progression requiring instrumentation. The average time to surgical intervention for the indication of progressive kyphosis was 2.6 months after prior laminectomy and 6 months after initiation of medical management.
CONCLUSIONS
CONCLUSIONS
Given the proclivity for kyphotic deformity at the TL junction, patients may benefit from long segment instrumentation in addition to decompression at the initial surgery. Laminectomy alone may hasten kyphosis progression.
Identifiants
pubmed: 32986577
pii: 7073
doi: 10.14444/7073
pmc: PMC7477994
doi:
Types de publication
Journal Article
Langues
eng
Pagination
552-558Informations de copyright
This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2020 ISASS.
Références
Spine (Phila Pa 1976). 2010 Oct 15;35(22):E1221-9
pubmed: 20562730
Neurosurg Focus. 2004 Dec 15;17(6):E4
pubmed: 15636574
Spine (Phila Pa 1976). 2006 Nov 1;31(23):2695-700
pubmed: 17077738
Clin Infect Dis. 2002 May 15;34(10):1342-50
pubmed: 11981730
Spine J. 2017 Aug;17(8):1120-1126
pubmed: 28414168
Spine (Phila Pa 1976). 1989 Mar;14(3):284-91
pubmed: 2652335
Spine (Phila Pa 1976). 1986 Jun;11(5):418-20
pubmed: 3750078
J Spinal Disord Tech. 2006 Jul;19(5):376-82
pubmed: 16826013
Qual Life Res. 1998 Feb;7(2):155-66
pubmed: 9523497
Spine (Phila Pa 1976). 2004 Feb 1;29(3):326-32; discussion 332
pubmed: 14752357
Neurosurg Focus. 2014 Aug;37(2):E2
pubmed: 25081962
J Bone Joint Surg Am. 1997 Jun;79(6):874-80
pubmed: 9199385
Spine (Phila Pa 1976). 1998 Sep 1;23(17):1885-90
pubmed: 9762746
Baillieres Clin Rheumatol. 1995 Feb;9(1):151-9
pubmed: 7728878
Int Orthop. 2007 Feb;31(1):113-9
pubmed: 16708233
Spine (Phila Pa 1976). 2008 Oct 1;33(21):E759-67
pubmed: 18827680
Neurosurgery. 1999 May;44(5):1018-25; discussion 1025-6
pubmed: 10232535
Spine J. 2004 Jul-Aug;4(4):388-95
pubmed: 15246297
Neurosurg Focus. 2004 Dec 15;17(6):E2
pubmed: 15636572
J Neurosurg. 2001 Jan;94(1 Suppl):1-7
pubmed: 11147842
Clin Orthop Relat Res. 1991 Aug;(269):142-50
pubmed: 1864031
Spine J. 2014 Jul 1;14(7):1139-46
pubmed: 24139231
Clin Infect Dis. 2015 Sep 15;61(6):859-63
pubmed: 26316526
J Spinal Disord. 1999 Feb;12(1):17-26
pubmed: 10078945
Neurosurg Focus. 2014 Aug;37(2):E5
pubmed: 25081965
BMC Musculoskelet Disord. 2017 Apr 27;18(1):175
pubmed: 28449655
Spine (Phila Pa 1976). 2007 Apr 20;32(9):E275-80
pubmed: 17450059
Spine (Phila Pa 1976). 1997 Apr 1;22(7):780-5
pubmed: 9106320
Clin Orthop Relat Res. 2006 Mar;444:27-33
pubmed: 16523124
J Bone Joint Surg Am. 1983 Jan;65(1):19-29
pubmed: 6849675
Eur Spine J. 2013 Mar;22(3):633-41
pubmed: 22922802
Eur Rev Med Pharmacol Sci. 2012 Apr;16 Suppl 2:35-49
pubmed: 22655482
Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33
pubmed: 16227897
J Antimicrob Chemother. 2010 Nov;65 Suppl 3:iii11-24
pubmed: 20876624
Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1572-9
pubmed: 22996263