Abstract
Osteomyelitis has long been one of the most common, difficult and challenging problem confronted by the surgeons in daily practice. The key to successful management is early diagnosis and appropriate treatment. The first line in treatment of vertebral osteomyelitis is conservative. There is an increased risk of deep infection with the use of spinal instrumentation. Therefore, the placement of implants in an infected area remains a matter of debate. We present two patients with lumbar vertebral osteomyelitis using antibiotic impregnated PMMA for vertebral body reconstruction and pedicle screw fixation. Post-operative follow-up showed satisfactory results both symptomatically and neurologically. The antibiotic impregnated bone cement acts as both interbody spacer and an antibiotic carrier. However, long term outcomes in both the cases requires further evaluation.
Highlights
Osteomyelitis is defined as inflammation of bone and its marrow due to microorganisms
Osteomyelitis has long been one of the most common, difficult and challenging problem confronted by the surgeons in daily practice
Vertebral osteomyelitis was recognized as a distinct clinical entity by Hippocrates and Galen
Summary
Osteomyelitis is defined as inflammation of bone and its marrow due to microorganisms. The infection involves the marrow spaces, the haversian canals and the subperiosteal space. Vertebral osteomyelitis was recognized as a distinct clinical entity by Hippocrates and Galen. In the early 1990s, about 20% of patients with osteomyelitis died and patients who survived had significant morbidity. The first line of treatment in vertebral osteomyelitis is conservative. Studies show that high antibiotic concentrations in local lesion can be achieved by releasing antibiotic agent mixed with PMMA beads chain into surrounding soft tissues. Antibiotic PMMA beads chain has been used in treating patients with open fractures, chronic osteomyelitis, total joint arthroplasty and soft tissue infections for decades[2],[4][8],[9][12],[13]. The antibiotic impregnated bone cement acts as both interbody spacer and an antibiotic carrier
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