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Abstract
Objectives
To evaluate how the timing of pedicle screw fixation (early or late) in pyogenic spondylitis relates to the period of hospitalization, duration of intravenous antibiotic use, and recurrence of infection and to confirm the efficacy of early pedicle screw fixation for pyogenic spondylitis.
Summary of Literature Review
Intravenous antibiotics and surgery including debridement and fixation are used as a treatment option for pyogenic spondylitis.
Materials and Methods
We retrospectively reviewed 31 patients who underwent posterior decompression and pedicle screw fixation with intravenous antibiotic treatment for pyogenic spondylitis from November 2005 to February 2015. We divided the study group into an early fixation group, whose instrumentation was inserted no later than 15 days after antibiotic therapy, and a late fixation group for cases who underwent the procedure 15 days or more after antibiotic therapy. We compared the period of hospitalization and intravenous antibiotic treatment, the rate and period of the prescription of oral antibiotics, and the rate of recurrence or reoperation.
Results
The period of hospitalization and intravenous antibiotic treatment of the early fixation group (55 and 43.4 days) were significantly shorter than those of the late fixation group (85 and 67.1 days). The rate and period of the prescription of oral antibiotics were not significantly different between the two groups. There was no case of recurrence or reoperation in either group.
REFERENCES
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Fig. 1.
Case of early fixation with pedicle screw and rod system on pyogenic spondylitis. Single-stage posterior decompression and posterior lumbar interbody fusion with pedicle screw and autograft was performed. (A) Sagittal enhanced MRI showing endplate destruction and high signal intensity cen-tered on the disc space and epidural space. (B) Axial enhanced MRI showing high signal intensity on the psoas muscle, intervertebral disc, and epidural space. (C) Anteroposterior image after the operation. (D) Lateral image after the operation.
Fig. 2.
Case of late fixation with a pedicle screw and rod system on pyogenic spondylitis. Anterior decompression and tricortical bone graft was performed. After that operation, a staged operation of posterior pedicle screw fixation was performed. (A) Sagittal enhanced MRI showing high signal intensity on the disc space and vertebral body. (B) Axial enhanced MRI showing high signal intensity on the psoas muscle, intervertebral disc, and epidural space. (C) Anteroposterior image after surgery. (D) Lateral image after surgery.
Table 1.
Demographic data. No significant differences were shown in age, sex, and pathogen between two groups
| Demographic variables | Early operation group | Delayed operation group | p-value |
|---|---|---|---|
| Number of patients | 15 | 16 | |
| Age distribution (years) | 61.1 ± 11.7 | 58.6 ±15.4 | 0.617 |
| Sex (M:F) | 11:4 | 10:6 | 0.704 |
| BMI | 21.9 ± 4.6 | 23.0 ± 3.4 | 0.453 |
| Underline disease (#) | |||
| Liver cirrhosis | 1 | 0 | 0.484 |
| Chronic kidney disease | 2 | 2 | 1.00 |
| Diabetic mellitus | 8 | 8 | 1.00 |
| Cardiovascular disease | 5 | 8 | 0.475 |
| Malignancy | 0 | 1 | 1.00 |
| Pathogen (#) | |||
| MRSA∗ | 4 | 6 | 0.704 |
| MRCNS† | 1 | 0 | 0.484 |
| K. pneumoniae‡ | 1 | 2 | 1.00 |
| CNS§ | 1 | 1 | 1.00 |
| Enterobacter | 1 | 1 | 1.00 |
| MSSA | 1 | 0 | 0.484 |
| Enterococcus | 1 | 0 | 0.484 |
| GBS∥ | 1 | 0 | 0.484 |
| P. aeruginosa¶ | 1 | 0 | 0.484 |
| Unknown | 3 | 6 | 0.433 |
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