The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis

Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143-0350, USA.
Neurosurgery (Impact Factor: 3.62). 02/2009; 64(1):122-9; discussion 129-30. DOI: 10.1227/01.NEU.0000336332.11957.0B
Source: PubMed


The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented.
Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12-L1), 5 lumbar, and 3 lumbosacral (involving L5-S1) lesions. The most frequently identified organisms were Staphylococcus aureus, Mycobacterium tuberculosis, and Coccidioides immitis. Imaging studies included x-rays, computed tomographic scans, and magnetic resonance imaging scans. All patients were treated with corpectomies and expandable cage reconstruction. Fusion was performed with rib autograft, iliac crest autograft, or allograft. Most patients who had an anterior approach also underwent posterior instrumentation, whereas a few had anterior instrumentation only. Four patients underwent a posterior approach (transpedicular corpectomy) only.
The median follow-up period was 21 months. There were no implant failures. Two recurrences of infection were noted: 1 case involved allograft, and the other involved autograft. At follow-up, neurological deficits improved in all patients, and 81% of patients were pain-free.
This study suggests that the treatment of vertebral column osteomyelitis can be performed with expandable titanium cages, and allograft does not appear to increase the rate of recurrence, as compared with autograft.

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    • "The pedicles are then taken down, exposing the vertebral body for corpectomy and adjacent level discectomy. Multiple techniques have been described for placement of an expandable cages in the transpedicular approach: including thecal sac mobilization, rib head osteotomy, rib head disarticulation, and trap-door rib head osteotomy, with thinning of the rib to allow greenstick fracture and displacement with subsequent displacement [47, 52, 53]. "
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