Surgical Treatment in Patients with Cervical Osteomyelitis: Single Institute's Experiences.
10.14245/kjs.2014.11.3.162
- Author:
Bang Sang HAHN
1
;
Kyung Hyun KIM
;
Sung Uk KUH
;
Jung Yoon PARK
;
Dong Kyu CHIN
;
Keun Su KIM
;
Yong Eun CHO
Author Information
1. Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea. kuhsu@yuhs.ac
- Publication Type:Original Article
- Keywords:
Cervical spine;
Spinal infection;
Osteomyelitis;
Spondylodiscitis
- MeSH:
Anti-Bacterial Agents;
Coagulase;
Congenital Abnormalities;
Debridement;
Diagnosis;
Discitis;
Humans;
Magnetic Resonance Imaging;
Methicillin Resistance;
Methicillin-Resistant Staphylococcus aureus;
Neurologic Manifestations;
Osteomyelitis*;
Retrospective Studies;
Spine;
Streptococcus;
Tuberculosis
- From:Korean Journal of Spine
2014;11(3):162-168
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To study practical guidelines and strategies in the treatment of cervical osteomyelitis. METHODS: We retrospectively reviewed 14 patients who underwent surgical treatment for cervical osteomyelitis from May 2000 to July 2008. We investigated their clinical course, antibiotic regimen, surgical methods, and laboratory and radiologic findings including X-ray, CT and MRI. RESULTS: 5 patients had primary spondylodiscitis, 5 patients had post operative spondylodiscitis and 4 patients had tuberculosis in cervical spine. The causative microorganisms were MRSA (5), P. aeruginosa (1), Methicillin resistant coagulase negative streptococcus (1), P. aeruginosa changed to MRSA (1), and 2 patients showed no growth on culture studies. Patients were treated 13.8 weeks (range, 5.4-25.8) with IV antibiotics and then treated for 58.2 days (range, 13-106) with oral antibiotics. Antituberculotic medications were used for a mean of 383.8 days. Patients were treated with anterior debridement and fusion (5), irrigation and debridement (5), simultaneous cervical anterior interbody and transthoracic thoracic interbody fusion (1). 3 patients underwent the planned 2-staged operation, which included an anterior debridement with or without fusion for the 1st operation and posterior instrumentation for 2nd operation. 10 patients (71.4%) had neurologic deficits at the time of diagnosis and 7 patients (70%) among them improved post-operatively. CONCLUSION: Anterior cervical spine surgery is the preferable treatment option in patients with neurological deterioration, extensive bony destruction with expected kyphotic deformity, and uncontrolled infection being managed only with antibiotics. Antibiotics are also important for thorough treatment.
