Background
Pyogenic spinal infection (PSI) is the most common cause of spinal infection, affecting mainly the vertebral body. Nonoperative treatment is associated with high failure and mortality rates, especially in patients with impaired immune system. There is debate as regards the most appropriate approach and whether to use an implant at the infected site immediately or to wait for a second stage after a period of antibiotic coverage and whether to use one or combined anteroposterior approaches.
Objective
The aim of this work was to study the results of single-stage debridement, bone graft and immediate internal fixation for PSI cases through one approach.
Study design
This study was a retrospective review of 23 cases of PSI.
Patients and methods
The medical records, haematological results, radiological imaging, bacteriology and biopsy results of 23 patients of PSI were reviewed. The posterior approach was used in cases of thoracolumbar infection and the anterior approach was used in cervical spinal cases. Patients were treated with single-stage debridement, bone autograft and immediate internal fixation through the same approach, followed by parenteral antibiotics for 4–6 weeks and oral antibiotics until normalization of the inflammatory markers with good clinical and radiological response. Functional results were assessed using the Oswestry disability index questionnaire and the physical function domain score of SF-36 questionnaire.
Results
All patients showed complete resolution of infection and achieved solid bony fusion in a sound position without chronicity, relapse or persistence of infection. All patients showed neurological recovery and returned to their preoperative activity with good functional outcome as evidenced by significant improvement in the preoperative Oswestry disability index mean score and the physical function domain score of SF-36 questionnaire.
Conclusion
Single-stage single-approach surgical debridement, interbody fusion using bone graft and immediate internal fixation, is a safe and effective treatment for PSI.