Posterior fixation for pyogenic spondylitis following osteoporotic vertebral fracture: A retrospective study of five challenging cases

Background

Pyogenic spondylitis following osteoporotic vertebral fracture is rare but serious with a poor clinical outcome. Although posterior fixation is an effective treatment for pyogenic spondylitis, surgical outcomes following osteoporotic vertebral fractures remain largely unreported. We present the outcomes of five challenging cases treated with posterior fixation.

Methods

We retrospectively evaluated patients who underwent posterior fixation for pyogenic spondylitis between January 2021 and July 2023. Five patients with pyogenic spondylitis following osteoporotic vertebral fracture were identified. We examined the age, sex, location of the vertebral fracture and infection, time from fracture to infection diagnosis, C-reactive protein levels, causative organisms, antibiotic therapy, operative procedures, and clinical outcomes.

Results

Three male and two female patients were included; they had a mean age of 75.4 years (standard deviation [SD], 7.1; range, 65–83 years). The mean time from fracture to diagnosis was 37.0 days (SD, 15.9; range, 21–55 days). All causative organisms were identified. Initial posterior fixation proved insufficient in four of the five patients, and additional surgery was required. The remaining patient developed significant screw backout. Additional procedures included fixation extension, anterior vertebral replacement, and fibular strut grafting. Infection control was achieved in all patients, and the mean follow-up duration was 20.4 months (SD, 9.9; range, 15–38 months).

Conclusions

We encountered five patients in whom posterior fixation alone proved insufficient for treating pyogenic spondylitis following osteoporotic vertebral fracture. Treatment strategies for this condition should address both infection control and spinal reconstruction, incorporating anterior column support and posterior fixation techniques.