Treatment of pyogenic XXXX with anterior debridement and fusion followed by delayed posterior spinal fusion.

@entity1 @entity6 @entity75 @entity4034 @entity794 @entity51 @entity85
STUDY DESIGN: Case series. OBJECTIVES: The results of surgical treatment of @entity4034 with anterior debridement and fusion followed by delayed posterior stabilization and fusion are presented. METHODS: Forty-two @entity1 with @entity4034 are presented. There were 5 cervical, 12 thoracic, 1 thoracolumbar, 19 lumbar, and 5 @entity75 . The most frequently identified organism was @entity794 . Most @entity1 had significant comorbidities, including @entity6 , or were immunocompromised. Ninety percent had elevated erythrocyte sedimentation rates and C-reactive proteins, while white blood cell counts were less reliably elevated. Imaging studies included radiographs, CT scans, and MRIs. All @entity1 were treated with anterior debridement and strut grafting followed by 14.4 days of intravenous antibiotics and delayed instrumented posterior fusions and received 6 weeks of intravenous antibiotics after surgery. RESULTS: All @entity1 had resolution of their infections with no recurrence. There were two deaths. @entity51 resolved in all @entity1 . The diagnosis of pyogenic @entity4034 is frequently delayed and presents a significant surgical challenge. The indications for surgical debridement were neurologic compromise, failed medical treatment, soft tissue extension, extensive vertebral body and disc space destruction, and progressive @entity85 . Many of these @entity1 were severely ill at presentation and required urgent treatment. Anterior debridement and fusion followed by intravenous antibiotics allows for restoration of anterior column support and control of the infection before posterior instrumentation and fusion. CONCLUSION: This study demonstrates that anterior surgical debridement with fusion, followed by a period of intravenous antibiotics and delayed instrumented posterior fusion, is highly effective in the treatment of pyogenic @entity4034 that has failed medical management.
