Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases.

BACKGROUND: Thirty-three patients with nontuberculous pyogenic thoracic and lumbar vertebral osteomyelitis were treated surgically. Indications for surgery were either progression of disease despite adequate antibiotic therapy, neurologic deficit, or both. The most common initial symptom was back pain. Seven patients had diabetes, seven patients were intravenous drug users, two patients were receiving immunosuppressive therapy, and seven patients had a debilitating disease. Eleven had infections elsewhere in their bodies. Prior to surgery organisms were grown from blood in 10 patients and at surgery in 15 patients. METHODS: Infection was evident on plain films in all patients, and either a CT scan or MRI was obtained in each. The lateral extracavitary approach was used for resection of granulation tissue and infected bone ventral to the dura. Interbody bone grafts were placed in 19 patients, usually when bone resection was extensive. Posterior instrumentation was placed in 17 patients at a second procedure 10 days-2 weeks following initial operation. Intravenous antibiotics were administered for 4-6 weeks following surgery, and solid fusion was obtained in all patients. RESULTS: Neurologic deficit was present in 28 patients prior to surgery and was functionally significant in 18 patients. Of the 11 patients with severe paraparesis, 10 achieved good functional recovery. These patients were able to walk, three with assistance and seven without, and all those who were unable to void regained this ability. CONCLUSIONS: Surgical debridement, interbody fusion, and posterior instrumentation is a safe and effective treatment for vertebral osteomyelitis and is indicated when neurologic deficit or bone destruction progress despite adequate antibiotic therapy.

Surgical management of lumbar neuropathic spinal arthropathy (Charcot joint) after traumatic thoracic paraplegia: report of two cases.

Two cases of successful surgical treatment of neuropathic spinal arthropathy (Charcot joint) are reported. Each patient was first seen several years after traumatic paraplegia. One patient had progressive kyphosis and the other had severe pain. Symptoms were relieved in both patients after interbody fusion and posterior fixation by using the lateral extracavitary approach to the spine. Both patients remain symptom free several years after the surgery. Fusion should be performed in symptomatic patients with neuropathic spinal arthropathy: this can be combined with posterior fixation in a single stage by using the lateral extra-cavitary approach.

Neurologic recovery in quadriplegia following operative treatment.

Records and radiographs of 90 patients suffering complete or motor-complete quadriplegia and treated surgically were reviewed. There were 76 men or boys and 14 women or girls; ages ranged from 15 to 75. Eighty-one were complete quadriplegics and nine had some degree of sensory preservation. After surgery 30 were unchanged, 47 obtained root recovery, and 13 recovered cord function, including two who became ambulatory. Fifty-three of the 74 (71%) patients undergoing decompressive procedures showed neurological improvement while seven of the 16 (49%) patients with fusion and no root decompression had improvement (p less than 0.05). All 26 patients with dislocations underwent closed or open reduction as part of their operative procedures; this did not appear to improve the likelihood of nerve root recovery. Since independence and quality of life may be improved by cord and root recovery, decompression of all neural structures should be considered in cervical spinal cord injury.