The use of porous tantalum cages in the treatment of unremitting spondylodiscitis: a case report
Abstract
Background: Unsuccessful medical treatment of pyogenic multifocal spondylodiscitis including signs of sepsis and unremitting pain is challenging. The aim of our report was to present a case of multilevel spondylodiscitis successfully treated by posterior lumbar interbody fusion using porous tantalum cages.
Case presentation: A 59-year-old male was diagnosed with spondylodiscitis at T8-T9 level. Although treated with antibiotics, the patient again presented with worsening of systemic signs of infection and back pain. Contrast-enhanced magnetic resonance imaging studies revealed spondylodiscitis at L1 to S1 level. Posterior lumbar interbody bone fusion with tantalum cages from L1 to S1 was performed. The inflammation rapidly subsided. Computer tomography studies showed a stable construct at 24 months.
Conclusion: Porous tantalum cages used in combination with transpedicular fixation seem to be a sound alternative to interbody devices made from other materials when treating spondylodiscitis cases without definite osseous destruction.
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References
Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop. 2012;36(2):413–20.
Klemenc-Ketiš Z, Kersnik, J. One month prevalence of self–reported musculoskeletal pain syndromes and correlates. A Med–Biotech. 2012;5(2):40–4.
Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect. 2007;55(2):158–63.
Chen WH, Jiang LS, Dai LY. Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J. 2007;16(9):1307–16.
Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S. Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine (Phila Pa 1976). 2006;31(9):1014–9.
Kuklo TR, Potter BK, Bell RS, Moquin RR, Rosner MK. Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 2006;19(5):376–82.
Mondorf Y, Gaab MR, Oertel JM. PEEK cage cervical ventral fusion in spondylodiscitis. Acta Neurochir (Wien). 2009;151(11):1537–41.
Zimmerli W. Vertebral Osteomyelitis. New England Journal of Medicine. 2010;362(11):1022–9.
Babouee Flury B, Elzi L, Kolbe M, Frei R, Weisser M, Schären S, et al. Is switching to an oral antibiotic regimen safe after 2 weeks of intravenous treatment for primary bacterial vertebral osteomyelitis? BMC Infectious Diseases. 2014;14(1).
Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clinical Infectious Diseases. 2015;61(6):e26-e46.
Moličnik A, Hanc M, Rečnik G, Krajnc Z, Rupreht M, Fokter SK. Porous tantalum shells and augments for acetabular cup revisions. European Journal of Orthopaedic Surgery & Traumatology. 2013;24(6):911–7.
Sagomonyants KB, Hakim-Zargar M, Jhaveri A, Aronow MS, Gronowicz G. Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients. J Orthop Res. 2011;29(4):609–16.
Hanc M, Fokter SK, Vogrin M, Molicnik A, Recnik G. Porous tantalum in spinal surgery: an overview. Eur J Orthop Surg Traumatol. 2016;26(1):1–7.
Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine (Phila Pa 1976). 1993;18(13):1890–4.
Calvert G, May LA, Theiss S. Use of permanently placed metal expandable cages for vertebral body reconstruction in the surgical treatment of spondylodiscitis. Orthopedics. 2014;37(6):e536–42.
Walter J, Kuhn SA, Reichart R, Kalff R, Ewald C. PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series. Eur Spine J. 2010;19(6):1004–9.
Schomacher M, Finger T, Koeppen D, Süss O, Vajkoczy P, Kroppenstedt S, et al. Application of titanium and polyetheretherketone cages in the treatment of pyogenic spondylodiscitis. Clin Neurol Neurosurg. 2014;127:65–70.
Gorensek M, Kosak R, Travnik L, Vengust R. Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine. Eur Spine J. 2013;22(3):633–41.
D’Aliberti G, Talamonti G, Villa F, Debernardi A. The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients. Eur Spine J. 2012;21 Suppl 1:S75–82.
Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC. Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine (Phila Pa 1976). 2003;28(9):902–8.
Emery SE, Chan DP, Woodward HR. Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine (Phila Pa 1976). 1989;14(3):284–91.
Ruf M, Stoltze D, Merk HR, Ames M, Harms J. Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cage. Spine (Phila Pa 1976). 2007;32(9):E275–E80.
Chang CC, Merritt K. Infection at the site of implanted materials with and without preadhered bacteria. J Orthop Res. 1994;12(4):526–31.
Grob D, Daehn S, Mannion AF. Titanium mesh cages (TMC) in spine surgery. Eur Spine J 2005;14(3):211–21.
Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, et al. Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci. 2008;15(11):1240–5.
Mohamed AS, Yoo J, Hart R, Ragel BT, Hiratzka J, Hamilton DK, et al. Posterior fixation without debridement for vertebral body osteomyelitis and discitis. Neurosurg Focus. 2014;37(2):E6.
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