Medical Student The Ohio State University College of Medicine Columbus, Ohio, United States
Introduction: It is known that the spine has a global proclivity to develop segmental kyphosis over the natural history of pyogenic vertebral osteomyelitis (PVO). Whether corpectomy or laminectomy with fusion or laminectomy alone corrects the original kyphotic deformity and prevents further progression of the kyphotic deformity is unknown. The aim of this study was to assess the utility of these procedures towards this end.
Methods: An institutional consecutive series of 92 adult patients with PVO who underwent surgery were screened for postoperative follow-up of at least three months, which yielded 81 patients. Surgical patients’ MRI radiographs were evaluated for deformity of the segment following surgery. Exclusion criteria included radiographic follow-up of fewer than three months.
Results: The average follow-up interval for patients was 391.5 days. Twenty patients underwent corpectomy, 29 underwent laminectomy, and 28 underwent laminectomy with fusion for a median of one affected level of the subaxial. Preoperative kyphosis was greatest¬ in the corpectomy group (18.7°) versus the laminectomy group with fusion (5.0°) and without fusion (-4.9°) (p < 0.0001). On follow-up, patients who underwent corpectomy had the least progression of segmental kyphosis postoperatively (-7.7°) versus laminectomy with (-0.3°) and without fusion (6.7°) (p = 0.0003).
Conclusion : Despite corpectomy being used in the most severe kyphotic deformity, as expected, it prevented the progression of and corrected kyphosis. Laminectomy without fusion did not prevent the progression of kyphosis, but with fusion it did. In patients with PVO, it should be noted that laminectomy and debridement alone may not be sufficient to prevent the progression of segmental kyphotic deformity postoperatively.
How to Improve Patient Care: Decompressive laminectomy alone does not appear to prevent the progression of segmental kyphotic deformity that occurs over the natural history of PVO, so avoid in cases of severe or contiguous segmental deformity.
