Korean J Spine.  2014 Sep;11(3):162-168. 10.14245/kjs.2014.11.3.162.

Surgical Treatment in Patients with Cervical Osteomyelitis: Single Institute's Experiences

• Hahn BS
• Kim KH
• Kuh SU
• Park JY
• Chin DK
• Kim KS
• Cho YE

• KMID: 1885673
• DOI: http://doi.org/10.14245/kjs.2014.11.3.162

Abstract

OBJECTIVE
To study practical guidelines and strategies in the treatment of cervical osteomyelitis.
METHODS
We retrospectively reviewed 14 patients who underwent surgical treatment for cervical osteomyelitis from May 2000 to July 2008. We investigated their clinical course, antibiotic regimen, surgical methods, and laboratory and radiologic findings including X-ray, CT and MRI.
RESULTS
5 patients had primary spondylodiscitis, 5 patients had post operative spondylodiscitis and 4 patients had tuberculosis in cervical spine. The causative microorganisms were MRSA (5), P. aeruginosa (1), Methicillin resistant coagulase negative streptococcus (1), P. aeruginosa changed to MRSA (1), and 2 patients showed no growth on culture studies. Patients were treated 13.8 weeks (range, 5.4-25.8) with IV antibiotics and then treated for 58.2 days (range, 13-106) with oral antibiotics. Antituberculotic medications were used for a mean of 383.8 days. Patients were treated with anterior debridement and fusion (5), irrigation and debridement (5), simultaneous cervical anterior interbody and transthoracic thoracic interbody fusion (1). 3 patients underwent the planned 2-staged operation, which included an anterior debridement with or without fusion for the 1st operation and posterior instrumentation for 2nd operation. 10 patients (71.4%) had neurologic deficits at the time of diagnosis and 7 patients (70%) among them improved post-operatively.
CONCLUSION
Anterior cervical spine surgery is the preferable treatment option in patients with neurological deterioration, extensive bony destruction with expected kyphotic deformity, and uncontrolled infection being managed only with antibiotics. Antibiotics are also important for thorough treatment.

Keyword

Cervical spine; Spinal infection; Osteomyelitis; Spondylodiscitis

MeSH Terms

Anti-Bacterial Agents
Coagulase
Congenital Abnormalities
Debridement
Diagnosis
Discitis
Humans
Magnetic Resonance Imaging
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Neurologic Manifestations
Osteomyelitis*
Retrospective Studies
Spine
Streptococcus
Tuberculosis
Anti-Bacterial Agents
Coagulase