Pyogenic Spine Infections - New Perspectives

Introduction:

Pyogenic Spine Infections (PSI) is a term describing the continuum of bacterial infections involving the spine – vertebral osteomyelitis, discitis and epidural abscess. Several facets of management of PSI remain controversial. For example, the prognosis of patients presenting with profound neurological compromise is generally viewed as poor. Also, spinal instrumentation in the presence of infection has been traditionally questioned. This review of PSI seeks to address and shed light on these two issues.

Methods:

A review of all PSI managed at our institution between May'96 and June '99 was performed. Only bacterial infections were considered. A total of 50 patients underwent 61 hospitalizations. 11 admissions represented relapses. Of the 61, 17 admissions were for neurological deficits. 12 patients underwent emergent/urgent decompression for these deficits. Their pre–operative neurological status was either markedly (Frankel A–C) or mildly (Frankel D–E) impaired. The 5 who did not undergo surgery were deemed to be relatively stable (Frankel D or better) or were unwilling or medically unsuitable for surgery. Results: Of the 12 surgical patients presenting with deficit, 1O experienced either stabilization (3) or improvement (7) of their neurological condition. Two patients expired. In all 21 PSI admissions were managed surgically and 40 with antibiotics alone. Eleven patients had hardware implanted. No surgical case relapsed or needed any longer antibiotic treatment than those managed medically.

Conclusions:

Rapid surgical decompression can result in substantial improvement in PSI with neurological compromise. The use of spinal instrumentation in the presence of infection is safe and effective.