Does acute placement of instrumentation in the treatment of vertebral osteomyelitis predispose to recurrent infection - Long-term follow-up in immune-suppressed patients

Study Design. Single institution, prospective observation study. Objective. To determine the long-term clinical outcomes of immune-suppressed patients with pyogenic vertebral osteomyelitis (PVO) treated with spinal instrumentation in the setting of active infection. Summary of Background Data. The mainstay of treatment for PVO remains nonoperative. Surgical indications include neurologic compromise, deformity, abscess and failure of medical management. Some authors have been concerned regarding risk of local infection reoccurrence when spinal instrumentation has been placed in the setting of active infection. To our knowledge no long-term follow-up has been reported for this condition. Methods. Thirty-two consecutive immune compromised patients with PVO were treated with debridement and spinal instrumentation in the setting of acute infection at a single institution. Patients were observed by a set protocol and evaluated for reoccurrence of infection at regular intervals for up to 10 years. Results. The 32 patients in our study group had significant medical comorbidities and were immune compromised. All patients were treated with single stage debridement and instrumented fusion during active infection. Twenty-two patients had a full 10 years follow-up without clinical recurrence of the local infection. Four patients died during the observation period, and none had clinic or autopsy evidence of recurrence. One patient developed recurrent infection after 14 months and was successfully treated with repeat debridement and retention of the instrumentation. Although this patient had a chronically infected vascular shunt, he was disease free at final follow-up of 10 years. Four patients had their implants removed for pain, suspected nonunion or suspected recurrent infection. None of these patients had histologic or microbacteriological evidence of injection. Conclusion. The use of spinal instrumentation in immune-compromised patients with PVO is associated with a low risk of long-term recurrent infection.