Instrumentation of the infected and unstable spine: a review of 17 cases from the thoracic and lumbar spine with pyogenic infections.

A retrospective review of 17 consecutive cases of spinal instrumentation for pyogenic vertebral osteomyelitis (PVO) with follow-up of > 2 years was undertaken, to describe the clinical course and outcomes in patients with instrumentation of actively infected spines. In 17 patients with PVO, instrumentation of the spine was performed during the period of clinical infection. Twelve of 17 patients were immunocompromised because of systemic or iatrogenic factors. Five patients had a history of malignancy and four had had spinal irradiation. In all 17 cases, the infection appeared to clinically be controlled after instrumentation. All patients were mobilized directly after instrumentation. The erythrocyte sedimentation rate returned to normal in 15 patients without rheumatic disease and decreased by more than half in two patients with inflammatory arthritis. Four patients had died at follow-up, and none of these had signs of persistent infection. Eight cases had significant postoperative complications (47%), including two instrumentation failures and one wound dehiscence. Spinal instrumentation in selected cases of PVO allows early mobilization and did not seem to compromise the ability to clear infection. In certain recalcitrant cases, stabilization seemed to promote clinical resolution of the infection.