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  • Outcomes following Surgical Management of Vertebral Osteomyelitis

    Final Number:

    Jacob A. Miller BS; Rebecca Achey; Daniel Lubelski; Edward C. Benzel MD; Thomas E. Mroz MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Vertebral osteomyelitis is characterized by an acute or recurrent infection and the subsequent inflammatory destruction and new apposition of bone. In certain circumstances, instability of the spine or presence of neurologic deficits requires surgery. The associated morbidity after surgery has not been characterized in the literature.

    Methods: A retrospective chart review was conducted of all cases of surgically-managed vertebral osteomyelitis at the Cleveland Clinic from 2002-2010.

    Results: 24 patients were included in the study. 63% were male, with an average age of 58 and BMI of 27. 42% were current smokers and 17% had a history of intravenous drug abuse. The most common patient comorbidities were hypertension (54%), dyslipidemia (46%), and diabetes (38%). The most common sites of osteomyelitis were at L3 (50%), T12 (33%), L1 (33%), and L4 (33%), with only 17% in the cervical spine. On average, 4 levels were involved. Presenting symptoms included back pain (92%), fever (30%), lower extremity weakness (30%), upper and lower extremity radiculopathy (17%), and urinary incontinence (8%). On-admission, mean ESR was 76 and mean CRP was elevated at 6.9. 25% of patients had spine surgery within the previous 6 months. Upon admission, 100% of individuals received IV antibiotics and surgery. Antibiotic use included vancomycin (46%), cefazolin (17%), zosyn (17%), and quinolones (13%). Surgical procedures included corpectomy (33%), ALIF (21%), and ACDF (17%). No intraoperative complications occurred, and individuals were discharged after an average of 13 days (sd 11). The average follow-up period was 17 months (sd 15). 42% of individuals received revision surgery at an average of 74 days (sd 99) postoperatively. At last followup, 64% had long-term complications including chronic pain or radiculopathy (40%), numbness (20%), and muscle weakness (20%).

    Conclusions: While the presenting symptoms and surgical management of vertebral osteomyelitis are variable, 40% require revision operation and over 60% experience long-term neurologic complications.

    Patient Care: Outcomes data following surgically-managed cases of vertebral osteomyelitis will allow clinicians to make evidence-based decisions as to whether surgical or conservative management is appropriate for patients with osteomyelitis.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance and most common techniques in managing vertebral osteomyelitis 2) Discuss, in small groups, methods to reduce long-term neurologic complications and revision surgeries following vertebral osteomyelitis. 3) Identify a standardized surgical intervention in treating osteomyelitis with the purpose of reducing the incidence of revision operations.

    References: 1. Waldvogel, FA., Medoff, G., Swartz, MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. New England Journal of Medicine. 1970. 282: 198-206 2. Grammatico L, Baron S, Rusch E, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect 2008;136:653-660 3. Sapico, FL., Montgomeri, JZ. Vertebral Osteomyelitis. Infectious Disease Clinics of North America.1990. 4(3):539-550 4. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 2002;34:1342-1350 5. Zimmerli, Werner. Vertebral Osteomyelitis. New England Journal of Medicine. 2010. 362:1022-1029

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