Outcomes of Multi-Level Vertebrectomy for Spondylodiscitis

Publication date: Available online 3 August 2018

Source: The Spine Journal

Author(s): Nissim Ackshota, Alysa Nash, Ian Bussey, Mark Shasti, Luke Brown, Vijay Vishwanath, Zanaib Malik, Kelley E. Banagan, Eugene Y. Koh, Steven C. Ludwig, Daniel E. Gelb

Abstract

BACKGROUND CONTEXT

The incidence of pyogenic vertebral osteomyelitis (PVO) continues to increase in the United States, highlighting the need to recognize unique challenges presented by these cases and develop effective methods of surgical management. To date, no prior research has focused on the outcomes of PVO requiring two or more contiguous corpectomies.

PURPOSE

To describe our experience in the operative management of PVO in 56 consecutive patients who underwent multilevel corpectomies (≥2 vertebral bodies) via a combined approach.

STUDY DESIGN/SETTING

Single institution retrospective cohort review between January 2002 and December 2015. All patients had been treated at an academic tertiary referral center by one of two fellowship-trained orthopaedic spine surgeons.

PATIENT SAMPLE

Patient records were cross-referenced with International Classification of Diseases osteomyelitis codes and paravertebral abscess code. Inclusion criteria for the study were patients within the cohort who had adequate medical records for review, a minimum patient age of 18 years, active vertebral osteomyelitis as an indication for surgical intervention, a minimum of 1-year radiographic follow-up, and surgical intervention that included at least two complete vertebral corpectomies. Subsequently, 56 patients met the inclusion criteria and were reviewed for this retrospective analysis.

OUTCOME MEASURES

Outcomes of interest were readmission and reoperation rates related to treatment of PVO, 30-day and 1-year mortality rates, radiographic outcomes, perioperative complications, infection control, and length of stay.

METHODS

After IRB approval, retrospective review was performed on records of all adults with PVO refractory to standard nonoperative treatment who underwent complete corpectomy of two or more contiguous vertebrae at a single institution between January 2002 and December 2015. This study was unfunded, and no potential conflict of interest-associated biases were present.

RESULTS

Fifty-six patients were identified (63% male; mean age 56.8 years; mean radiographic follow-up 2.8 years). Median LOS was 13 days with nearly half readmitted (47%) after a median of 222.5 days after surgery. Twelve (22%) posterior revisions were required after a median 54 days for infection, painful or failed hardware, proximal junction kyphosis, adjacent level disease, or extension of the fusion. Thirty-day and 1-year mortality rate was 7.14% and 19.6%, respectively, with an infectious etiology as the most common cause of death.

CONCLUSIONS

Multi-level vertebral corpectomy for treatment of refractory vertebral osteomyelitis is associated with relatively high rates of complications and mortality compared to historical controls for 1 or 2 level procedures. We found clinical resolution and absence of complications requiring return to the operating room in 75% of patients when complete extirpation of the involved vertebrae is achieved. Our findings suggest multilevel anterior corpectomies with posterior stabilization may be a reasonable surgical option when approaching patients with complicated spondylodiscitis.

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