Management of Refractory Post-operative Osteomyelitis and Discitis: A Case Report

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Feb 20

PMID 38374846

Authors

Chase A DeLong

Malek Bashti

Long Di

Sumedh S Shah

Emade Jaman

Gregory W Basil

Affiliations

Soon will be listed here.

Abstract

Vertebral osteomyelitis/discitis is a relatively rare disease but is a known potential complication of spinal surgical intervention. In general, the first-line treatment for this condition is targeted antibiotic therapy with surgical intervention only utilized in refractory cases with evidence of extensive damage, structural instability, or abscess formation. However, surgical best practices have not been established for osteomyelitis, including indications for anterior lateral interbody fusion (ALIF), posterior lateral interbody fusion (PLIF), or direct lateral interbody fusion (DLIF). This case provides a discussion of the indications that led to a direct lateral approach in the setting of refractory osteomyelitis/discitis, supporting factors that led to its success, and the efficacy of utilizing intraoperative neuromonitoring in cases of infection.

References

Kasliwal M, Tan L, Traynelis V . Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int. 2013; 4(Suppl 5):S392-403. PMC: 3841941. DOI: 10.4103/2152-7806.120783. View

Pojskic M, SaB B, Vollger B, Nimsky C, Carl B . Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients. Bosn J Basic Med Sci. 2021; 21(5):587-597. PMC: 8381202. DOI: 10.17305/bjbms.2020.5261. View

Issa K, Diebo B, Faloon M, Naziri Q, Pourtaheri S, Paulino C . The Epidemiology of Vertebral Osteomyelitis in the United States From 1998 to 2013. Clin Spine Surg. 2017; 31(2):E102-E108. DOI: 10.1097/BSD.0000000000000597. View

Beculic H, Begagic E, Skomorac R, Jusic A, Efendic A, Selimovic E . A correlation of demographic characteristics, preoperative conservative therapy and timing with postoperative outcome in herniated disc-associated cauda equina syndrome: Do they really matter?. Med Glas (Zenica). 2023; 20(2):269-275. DOI: 10.17392/1630-23. View

Rodgers W, Gerber E, Patterson J . Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976). 2010; 36(1):26-32. DOI: 10.1097/BRS.0b013e3181e1040a. View

Kiss C, Connoley D, Connelly K, Horne K, Korman T, Woolley I . Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study. Antibiotics (Basel). 2022; 11(1). PMC: 8772790. DOI: 10.3390/antibiotics11010062. View

Walter G, Kemmerer M, Kappler C, Hoffmann R . Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int. 2012; 109(14):257-64. PMC: 3336146. DOI: 10.3238/arztebl.2012.0257. View

Timothy J, Pal D, Akhunbay-Fudge C, Knights M, Frost A, Derham C . Extreme lateral interbody fusion (XLIF) as a treatment for acute spondylodiscitis: Leeds spinal unit experience. J Clin Neurosci. 2018; 59:213-217. DOI: 10.1016/j.jocn.2018.10.063. View

Kim Y, Ha K, Rhyu K, Park H, Cho C, Kim H . Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls. Asian Spine J. 2020; 14(5):730-741. PMC: 7595814. DOI: 10.31616/asj.2020.0485. View

10.

Tani Y, Saito T, Taniguchi S, Ishihara M, Paku M, Adachi T . A New Treatment Algorithm That Incorporates Minimally Invasive Surgery for Pyogenic Spondylodiscitis in the Thoracic and Lumbar Spines: The Results of Its Clinical Application to a Series of 34 Patients. Medicina (Kaunas). 2022; 58(4). PMC: 9025525. DOI: 10.3390/medicina58040478. View

11.

Moller D, Slimack N, Acosta Jr F, Koski T, Fessler R, Liu J . Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity. Neurosurg Focus. 2011; 31(4):E4. DOI: 10.3171/2011.7.FOCUS11137. View

12.

Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Nuno M . Outcomes of decompression and fusion for treatment of spinal infection. Neurosurg Focus. 2019; 46(1):E7. DOI: 10.3171/2018.10.FOCUS18460. View

13.

Lau J, Kiss C, Roberts E, Horne K, Korman T, Woolley I . Surveillance of life-long antibiotics: a review of antibiotic prescribing practices in an Australian Healthcare Network. Ann Clin Microbiol Antimicrob. 2017; 16(1):3. PMC: 5241934. DOI: 10.1186/s12941-017-0180-6. View

14.

Grunert P, Drazin D, Iwanaga J, Schmidt C, Alonso F, Moisi M . Injury to the Lumbar Plexus and its Branches After Lateral Fusion Procedures: A Cadaver Study. World Neurosurg. 2017; 105:519-525. DOI: 10.1016/j.wneu.2017.06.027. View

15.

Mok J, Guillaume T, Talu U, Berven S, Deviren V, Kroeber M . Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine (Phila Pa 1976). 2009; 34(6):578-83. DOI: 10.1097/BRS.0b013e31819a827c. View

16.

Karikari I, Nimjee S, Hardin C, Hughes B, Hodges T, Mehta A . Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: initial clinical experience and early outcomes. J Spinal Disord Tech. 2010; 24(6):368-75. DOI: 10.1097/BSD.0b013e3181ffefd2. View

17.

Chen W, Jiang L, Dai L . Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J. 2006; 16(9):1307-16. PMC: 2200751. DOI: 10.1007/s00586-006-0251-4. View

18.

Raymaekers V, Roosen G, Put E, Vanvolsem S, Achahbar S, Meeuws S . Extreme Lateral Interbody Fusion as a Feasible Treatment for Thoracolumbar Spondylodiscitis: A Multicenter Belgian Case-Series. World Neurosurg. 2023; 172:e299-e303. DOI: 10.1016/j.wneu.2023.01.011. View

19.

Blizzard D, Hills C, Isaacs R, Brown C . Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci. 2015; 22(11):1758-61. DOI: 10.1016/j.jocn.2015.05.021. View

20.

Lew D, Waldvogel F . Osteomyelitis. Lancet. 2004; 364(9431):369-79. DOI: 10.1016/S0140-6736(04)16727-5. View