Clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty / 中华创伤骨科杂志

ABSTRACT

Objective:To report the clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty.Methods:Six cases of infectious spondylitis following vertebroplasty or kyphoplasty were analyzed retrospectively which had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital between January 2014 and June 2019. They were 2 males and 4 females, aged from 64 to 81 years. Their visual analogue scale (VAS) scores ranged from 6 to 8 points; their spinal cord function was graded as C in 2 cases and E in 4 according to the American Spinal Cord Injury Association (ASIA) grading. All the patients were treated by sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy. The therapeutic efficacy was assessed by the inflammation indexes, imaging examinations and clinical manifestations.Results:The 6 patients were followed up for 12 to 42 months(mean 20.4 months). Their operation time ranged from 295 to 455 min (mean 370.8 min) and blood loss from 760 to 2, 250 mL (mean 1 536.7 mL). There were no such serious complications as dural tear, worsening of neurological symptoms or death. The last follow-up revealed normal body temperature and fine incision healing in all patients. Their inflammatory indexes returned to normal. Imaging examinations at the last follow-up showed no displacement of internal implants, no screw loosening or breakage of screws or rods, good bony fusion at the grafting site, and no inflammatory signals from the infected vertebra. At the last follow-up, their VAS for back pain ranged from 2 to 4 points, the ASIA grading was improved from C to D in 2 patients and maintained E in 4. Eventually, 4 patients recovered independent normal walking but 2 required a walker.Conclusions:Infectious spondylitis following vertebroplasty or kyphoplasty can lead to back pain and neurological dysfunction. Sub-total resection of the infected vertebra, long segmental pedicle screw fixation and corresponding antibiotics therapy can result in fine therapeutic outcomes.