Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis.

INTRODUCTION: Between 1997 and 2006, we treated 11 patients with tuberculotic spondylitis and 19 with pyogenic spondylitis using a two-staged operation (posterior spinal instrumentation, followed by anterior debridement and fusion).
METHOD: We compared changes in inflammatory reactions, postoperative complications, organisms obtained during anterior debridement, neurological status, bone union, and suppression of the infection between the patients with tuberculotic and pyogenic spondylitis. PATIENTS: All patients in both groups achieved bone union and suppression of the infected sites. Decreases in C-reactive protein and erythrocyte sedimentation rate were significantly slower in the patients with tuberculotic spondylitis. Positive bacterial cultures at the second anterior debridement were obtained from 26% of patients with pyogenic spondylitis and 55% of patients with tuberculotic spondylitis. Frankel types improved in 57% of patients, but there were no differences in neurological improvement. The efficacy of the two-staged operation did not differ between the patients with pyogenic and tuberculotic spondylitis.
RESULTS: Although the baselines were different, there were no significant differences in relative operating parameters, neurological improvement, or postoperative complications between the two groups. At the final follow-up, all patients finally achieved suppression of spinal infection and solid bone fusion in both groups, although the decline in inflammatory parameters was slower in the T group than in the P group.