Introduction: Pedicle screws have been increasingly utilized for several spinal disorders, including infection. While a vast majority of reports have illustrated the success of lumbar pedicle screws, relatively fewer have done so for thoracic ones. Thus, through this study strives analyze the utility of thoracic pedicle screws for spinal osteomyelitis.

Methods: A retrospective review of all operatives performed by two neurosurgeons from 1999 to 2012 was conducted, which yielded 30 cases of thoracic osteomyelitis treated with pedicle screws. Patients with thoracic osteomyelitis but did not undergo pedicle screw fixation were excluded. 14 patients underwent posterior fusion only, and 16 underwent anterior and posterior fusion combined. Of the 30 patients, 3 died postoperatively. 2 were lost in the follow up 1 month after discharge. For the remaining 25 patients, the average of follow-up was 45 months. Postoperative records were analyzed for pertinent clinical and laboratory data.

Results: Of the 30 patients, 21 were males, 8 were females, and 1 was transsexual. Average age was 47 years old (range: 18 – 69). The most common organism cultured was Staphylococcus aureus, which was found in 12 cases. Three cases were positive for Staphylococcus epidermidis. Five cases were positive for multiple organisms, including Candida albicans, Microbacterium tuberculosis, Staphylococcus epidermidis, and Enterococcus faecium. Average antibiotic duration after discharge was 8 weeks (range: 0 – 24). Of the 25 patients with long-term follow-up, only 5 still showed clinical signs of osteomyelitis. Two of them required surgical revision.

Conclusions: On clinical follow-up, marked improvement or complete resolution was observed as follows: 89% for those initially presenting with pain; 83% for those with muscle weakness; and 100% for those suffering from urinary incontinence. This study advocates for larger studies as experience thus far has demonstrated the safety and efficacy of utilizing thoracic pedicle screws as a primary intervention to treat spinal osteomyelitis.

Patient Care: Our research will improve patient care by reporting on the safety and efficacy of utilizing thoracic pedical screws as a primary intervention to treat spinal osteomyelitis.

Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the important of pedicle screws for fixation of the thoracic spine. 2) Discuss, in small groups the of use of thoracic pedicle screw fixation to treat spinal osteomyelitis. 3) Identify thoracic pedicle screw fixation as an effective treatment for a variety of conditions including spinal deformities, fractures, and infection.

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