Article Figures & Data
Figures
- Figure
Preoperative magnetic resonance image (A) demonstrates focal T2 hyperintensity at T8–T9 consistent with discitis with an associated epidural phlegmon resulting in central stenosis. Postoperative radiographs (B and C) demonstrate a fusion of the T8 and T9 vertebral bodies 6 months after posterior fixation without debridement.
Tables
- Table 1
Diagnosis and management details of patients with vertebral body osteomyelitis and discitis treated with long-segment fusion in the absence of formal debridement.
Case Indication for Surgery Prior Treatment Levels of Disc Space and Bone Involvement Levels of Fixation Above Levels of Fixation Below Organism IV Antibiotic Type and Duration Oral Antibiotic Type and Duration 1 Osteomyelitis/discitis and bony instability IV antibiotics T11–T12 2 2 No growth on cultures None None 2 Osteomyelitis/discitis, neurological deficit, and bony instability IV antibiotics L4–L5 2 1 (to pelvis) No growth on cultures Daptomycin and Zosyn, 4 wk Doxycycline, Life 3 Epidural abscess and neurological deficit Laminectomy L3–L5 2 1 (to pelvis) Streptococcus mitis Ceftriaxone, 6 wk Not available 4 Epidural abscess, discitis, neurological deficit, and bony instability None T8–T9 2 4 MRSA Nafcillin, 6 wk Not available 5 Epidural abscess, neurological deficit, and bony instability None T5–T6 2 2 MRSA Vancomycin, 12 wk Doxycycline, Life 6 Osteomyelitis, epidural abscess, neurological deficit, and bony instability Oral fluconazole L1–L3 4 3 Candida None Fluconazole and Clindamycin, lost to follow-up 7 Discitis and bony instability IV antibiotics and laminectomy L5–S1 1 1 (to pelvis) MRSA Vancomycin and Daptomycin, 12 wk Doxycycline, Life 8 Osteomyelitis/discitis IV antibiotics L2–L3 1 1 MSSA Ceftriaxone, 4 wk Not available 9 Osteomyelitis, neurological deficit, and bony instability IV antibiotics L5–S1 1 1 (to pelvis) MSSA Vancomycin, 8 wk Not available 10 Osteomyelitis/discitis and bony instability None T7–T8 2 2 MRSA Vancomycin, 8 wk Doxycycline, Life 11 Osteomyelitis/discitis and neurological deficit Bracing L2–L3 1 1 Streptococcus anginosus Ceftriaxone, 6 wk Amoxicillin, Life 12 Osteomyelitis and bony instability IV antibiotics L2–L3 2 2 MSSA Cefazolin, 6 wk Doxycycline, Life 13 Epidural abscess, neurological deficit, and bony instability None T9–T10 3 3 No growth on cultures Vancomycin and ceftriaxone, 2 wk None 14 Osteomyelitis/discitis and bony instability IV antibiotics T9–T10 3 2 MRSA Vancomycin, 8 wk Doxycycline, Life 15 Epidural abscess and neurological deficit None T9–T10 3 3 MRSA Daptomycin, 8 wk Doxycycline, Life 16 Osteomyelitis/discitis, neurological deficit, and bony instability None T9–T10 2 3 Candida Fluconazole, 24 wk 17 Osteomyelitis, neurological deficit, and bony instability IV antibiotics T11–T12 2 2 Corynebacterium Vancomycin Amoxicillin, Life 18 Osteomyelitis/discitis and bony instability IV antibiotics L3–L4 1 2 (to pelvis) MSSA Ceftriaxone Doxycycline, Life 19 Discitis and epidural abscess IV antibiotics and computed tomography-guided psoas drainage L1–L4 1 1 MRSA Ceftaroline, Vancomycin Doxycycline, Life 20 Epidural abscess and neurological deficit IV antibiotics T6–T7 1 1 MSSA Cefazolin Not available 21 Osteomyelitis, epidural abscess, and neurological deficit None T11–L1 1 1 Streptococcus anginosus Penicillin, Vancomycin Amoxicillin, 24 wk 22 Discitis and neurological deficit IV antibiotics T9–T11 3 1 Escherchia coli Cetriaxone Not available 23 Discitis, epidural abscess, neurological deficit, and bony instability IV antibiotics L4–L5 2 1 (to pelvis) Klebsiella Ertapenem, Vancomycin Clindamycin, 52 wk 24 Discitis, neurological deficit, and bony instability None T9–T10 2 2 Aggregobacter aphrophilus CTX Levofloxacin, 52 wk 25 Discitis and bony instability IV antibiotics, oral fluconazole, irrigation, and debridement T11–T12 2 2 Candida Fluconazole, 24 wk 26 Osteomyelitis/discitis, neurological deficit, and bony instability IV antibiotics L2–L3 1 2 Peptostreptococcus Ertapenem Not available 27 Osteomyelitis and neurological deficit IV antibiotics T11–T12 2 2 MRSA Ceftaroline Bactrim, lost to follow-up Abbreviations: IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible Staphylococcus aureus.
Case Preoperative Neurological Deficit Preoperative Frankel Grade Postoperative Frankel Grade Ambulatory Status at Final Follow-Up Intraoperative Complications Postoperative Complications and Revision Surgery Hardware Removal 1 No D (baseline) C Wheelchair None First surgery was percutaneous stabilization; required revision anterior discectomy due to persistent infection Yes 2 Yes D E Ambulatory None Patient fell and required revision left iliac screw due to screw/rod dissociation Yes 3 Yes E E Ambulatory Dural tear (conversion from a laminectomy to a PSIF with repeat surgical decompression) None No 4 Yes E E Ambulatory None None No 5 Yes C D Walker None None No 6 Yes E E Ambulatory None None No 7 No E E Ambulatory None None No 8 No E E Ambulatory None 1 y postoperatively, the patient presented with available abscess after not taking antibiotics and loose hardware. I&D and hardware removal was performed. Yes 9 Yes E E Ambulatory None None No 10 No E E Ambulatory None None No 11 Yes D E Ambulatory None None No 12 No C (baseline) C Nonambulatory (baseline) None None No 13 Yes D C Nonambulatory (deceased) None Deceased 1 wk postoperatively due to hypoxia/cardiac arrest No 14 No E E Ambulatory None None No 15 Yes A B Nonambulatory (baseline) None Wound dehiscence successfully treated by local wound care No 16 Yes D E Ambulatory None None No 17 Yes D E Ambulatory None Patient developed severe kyphoscoliosis and required revision posterior/anterior with longer fusion construct No 18 No E E Ambulatory None None No 19 No D E Ambulatory None None No 20 Yes B Not assessed Not assessed None Deceased 9 d postoperatively due to cardiac arrest, anoxic brain injury No 21 Yes C C Nonambulatory None None No 22 Yes E C Ambulatory None None No 23 Yes D E Ambulatory None None No 24 Yes A C Stands with walker None None No 25 No E E Ambulatory, deceased None Pain and radiculopathy postoperatively requiring L4/5 decompression No 26 Yes D E Ambulatory None None No 27 Yes D E Ambulatory None None No Abbreviations: I&D, irrigation and debridement; PSIF, posterior spinal instrumentation and fusion.
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