POSTERIOR SUBTOTAL VERTEBRECTOMY FOR THE TREATMENT OF THORACIC OSTEOMYELITIS IN ELDERLY PATIENTS Meric ENERCAN, MD Cagatay OZTURK, MD Mehmet AYDOGAN, MD Selhan KARADERELER, MD Ahmet ALANAY, MD Azmi HAMZAOGLU, MD Istanbul Spine Center Florence Nightingale Hospital Istanbul-TURKEY

Vertebral osteomyelitis is usually treated by anterior decompression and stabilization but this approach may not be convenient especially in elderly patients with pulmonary co-morbidities. On the other hand, surgeons may hesitate to perform posterior debridement and stabilization with due to the concerns about contamination of the implants and difficulty in debridement and reconstruction of anterior column. INTRODUCTION

To evaluate posterior subtotal vertebrectomy for vertebral osteomyelitis in elderly patients with pulmonary comorbidity. Eleven elderly patients with chronic lung diseases were treated by posterior vertebral column resection and instrumentation to manage their thoracic vertebral osteomyelitis. PURPOSE PATIENT SAMPLE

There were 7 female and 4 male patients with a mean age of 67.3 (range; 50 to 83) years at the time of operation. Etiological diagnoses were spinal tuberculosis in 5 patients nonspecific spondylodiscitis in 6 patients (5 staphylococcus, 1 E. Coli). Surgical technique: After placement of pedicle screws, hemilaminectomy and costotransversectomy were performed at fracture level via a unilateral approach. Then, posterior decompression and subtotal vertebrectomy was accomplished. Titanium mesh cage was placed through the same incision. Contalateral posterior elements were preserved for fusion. METHODS

Preoperative, postoperative and 2 years follow-up A-P and lateral radiographies were evaluated in terms of local kyphosis angle and fusion rates. Hospital charts were evaluated in terms of complications and laboratory analysis (sedimentation rate and C-reactive protein). METHODS

There were 10 two-level and 1 four-level resections in thoracic spine. The mean operation time was 7.5 hours. The average blood loss was 935 ml. The average number of instrumentation level was 7.5. Average follow-up was 33 (24 to 60) months. RESULTS

The mean preoperative local kyphosis angle was 24.7 degrees; it was improved to 6.3 degrees at the early postoperative period and it was maintained at 7.7 degrees at the latest follow-up. Nine patients with partial neurological deficit had significant improvement. Postoperative deep infection in one and hematoma in one patient responded well to debridement surgery. None of the remaining patients required revision surgery for recurrence of infection or implant failure or pseudoarthrosis. RESULTS

MA, 60y, M, tuberculosis (T10-11)

Subtotal posterior vertebrectomy enabling decompression of the spinal canal and reconstruction of the resected vertebral segment was an efficient technique. This procedure eliminated the need for anterior approach which might have caused significant morbidity. CONCLUSION

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