Medical and surgical treatment of pyogenic spondylodiscitis.
2012
Background: Pyogenic verte- bral osteomyelitis (PVO) represents approxi- mately 2-7% of all cases of osteomyelitis. The approach to the treatment of PVO may be con- servative, which includes antibiotic therapy and orthopaedic treatment, or surgical. Aim: To overview conservative and surigical approaches to PVO. Methods: A literature review was performed using the Pubmed database to identify studies published in the last 20 years, addressing the treatment of PVO. Results: Empirical antibiotic treatment of PVO, while waiting for the results of cultures or in cul- ture-negative cases, should include broad spec- trum agents in association with agents active on Staphylococcus (S.) aureus. Based on local epi- demiological data, antibiotics active on methicillin resistant S. aureus (MRSA) should be included. Once an organism has been identified, antibiotics should be initially administered intravenously but the optimal duration of antimicrobial therapy is unclear. Studies have reported that the incidence of treatment failure was higher when i.v. therapy was administered for less than 4 weeks. Rifampin is widely used in the combination therapy of PVO, but no controlled trials are available to define weather this approach is beneficial. Many PVO need a surgical treatment and can represent a real challenge for the orthopaedic surgeon. Anterior and posterior cervical, thoracic, lumbar approach- es and the relatives surgical strategies are report- ed in this review. Moreover, recently the mininva- sive posterior stabilization have been proposed as a efficient alternative to open surgery in elderly with severe comorbidities. Possible advantages and limitations of this technique are also reported. Conclusions: Further research is needed in order to define the optimal duration of antibiotic therapy, and the benefits and limitations of open or mini-invasive surgical techniques.
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