Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2017; 8(9): 710-718
Published online Sep 18, 2017. doi: 10.5312/wjo.v8.i9.710
Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis
Shih-Chieh Yang, Hung-Shu Chen, Yu-Hsien Kao, Yuan-Kun Tu
Shih-Chieh Yang, Hung-Shu Chen, Yu-Hsien Kao, Yuan-Kun Tu, Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Author contributions: All the authors contributed to the manuscript
Institutional review board statement: This retrospective study was undertaken using data from medical records. This study was approved by the ethical committee of the E-DA hospital (EMRP: 105-064).
Informed consent statement: Our retrospective study contained data from medical records only. The study was registered based on the data protection agency of our institute.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Shih-Chieh Yang, MD, PhD, Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Kaohsiung 82445, Taiwan. ed102777@edah.org.tw
Telephone: +886-7-6150011-2972 Fax: +886-7-6155352
Received: February 13, 2017
Peer-review started: February 14, 2017
First decision: April 14, 2017
Revised: May 20, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: September 18, 2017
Abstract
AIM

To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage (TaMC) followed by immediate instrumentation.

METHODS

Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score (VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky’s criteria.

RESULTS

The average VAS score significantly decreased after the surgery (from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery (P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky’s criteria and significant improvement after the surgery (P < 0.001). No implant breakage or TaMC dislodgement was found during at least 24 mo of follow-up.

CONCLUSION

Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

Keywords: Anterior reconstruction, Complicated infectious spondylitis, Instrumentation, Spinal deformity, Tantalum mesh cage

Core tip: Complicated infectious spondylitis is a rare infection with vertebral pathological fracture and severe spinal destruction that require anterior reconstruction. The use of metallic implants for vertebral body stabilization and reconstruction following debridement at the lesion of infection remains controversial. In the present study a series of 20 patients with complicated infectious spondylitis were treated with single-stage anterior debridement and reconstruction using tantalum mesh cage (TaMC) followed by immediate instrumentation. The results demonstrated that good functional outcome and low complication rate could be achieved by a single-stage anterior debridement and reconstruction with TaMC.