Jihye Kim1, Jeong Hwan Lee2, Seok Woo Kim2, Jae-Keun Oh2, Young-Woo Kim3, Tae-Hwan Kim4. 1. Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul 05355, Republic of Korea. 2. Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea. 3. Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea. 4. Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea. Electronic address: paragon0823@gmail.com.
Abstract
BACKGROUND CONTEXT: In patients with pyogenic vertebral osteomyelitis (PVO) and previous instrumentation requiring surgical treatment, a decision must be made between a less-invasive noninstrumented surgery, including retaining the previous instrumentation, or a more invasive additional instrumented surgery involving the complete removal of the infected tissue and firm restabilization. PURPOSE: To evaluate the clinical outcomes of using additional instrumentation in patients with PVO and previous instrumentation and determine the significant risk factors related to recurrent infection. STUDY DESIGN/ SETTING: Retrospective cohort study (case control study). PATIENT SAMPLE: PVO patients with previous instrumentation. OUTCOME MEASURES: Recurrence of PVO and mortality. METHODS: Patients were divided into two groups (instrumented or noninstrumented) according to the presence or absence of additional instrumentation. The baseline characteristics, infection profile, and treatment outcomes were compared between the two groups, and a multivariate logistic regression analysis was performed to identify the risk factors for infection recurrence. RESULTS: A total of 187 postoperative patients with PVO and previous spinal instrumentation were included. There were no significant differences in the baseline characteristics except the presence of a titanium cage. Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality compared with noninstrumented surgery despite a larger number of involved vertebral levels and greater incidence of epidural abscesses. However, instrumented patients with PVO and previous instrumentation who experienced infection recurrence had worse clinical outcomes than those of the noninstrumented patients with PVO. Severe medical comorbidities, the presence of a psoas abscess, and methicillin-resistant Staphylococcus aureus infection were associated with a higher risk of infection recurrence. CONCLUSIONS: Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality to those who underwent noninstrumented surgery despite a larger number of involved vertebral levels and an increased frequency of epidural abscesses.
BACKGROUND CONTEXT: In patients with pyogenic vertebral osteomyelitis (PVO) and previous instrumentation requiring surgical treatment, a decision must be made between a less-invasive noninstrumented surgery, including retaining the previous instrumentation, or a more invasive additional instrumented surgery involving the complete removal of the infected tissue and firm restabilization. PURPOSE: To evaluate the clinical outcomes of using additional instrumentation in patients with PVO and previous instrumentation and determine the significant risk factors related to recurrent infection. STUDY DESIGN/ SETTING: Retrospective cohort study (case control study). PATIENT SAMPLE: PVO patients with previous instrumentation. OUTCOME MEASURES: Recurrence of PVO and mortality. METHODS:Patients were divided into two groups (instrumented or noninstrumented) according to the presence or absence of additional instrumentation. The baseline characteristics, infection profile, and treatment outcomes were compared between the two groups, and a multivariate logistic regression analysis was performed to identify the risk factors for infection recurrence. RESULTS: A total of 187 postoperative patients with PVO and previous spinal instrumentation were included. There were no significant differences in the baseline characteristics except the presence of a titanium cage. Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality compared with noninstrumented surgery despite a larger number of involved vertebral levels and greater incidence of epidural abscesses. However, instrumented patients with PVO and previous instrumentation who experienced infection recurrence had worse clinical outcomes than those of the noninstrumented patients with PVO. Severe medical comorbidities, the presence of a psoas abscess, and methicillin-resistant Staphylococcus aureus infection were associated with a higher risk of infection recurrence. CONCLUSIONS: Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality to those who underwent noninstrumented surgery despite a larger number of involved vertebral levels and an increased frequency of epidural abscesses.