Postoperative outcomes and complications after corpectomy for vertebral osteomyelitis: systematic review and meta-analysis

Background

While conservative treatment constitutes the mainstay of treatment for vertebral osteomyelitis (VO), aggressive surgical debridement is often warranted. We aim to assess the effectiveness of corpectomy for VO regarding neurological improvement, fusion, and infection recurrence.

Methods

A comprehensive literature search was conducted to identify studies investigating outcomes after corpectomy for VO. Random-effects model meta-analysis was performed, with neurological improvement being the primary endpoint. Subgroup analyses were conducted by anatomic location (cervical, thoracic, and lumbar) and cage type (expandable versus nonexpendable).

Results

Forty-four studies yielding 140 patients with a mean follow-up of 25.5 months were analyzed. The mean age at surgery was 57.3 years. Preoperative neurological deficits were present in 78.4 % of patients (95 % CI: 63.6 – 91 %); they improved in 71.8 % of these patients (95 % CI: 56.1 – 85.8 %). Complications occurred in 10.4 % (95 %CI: 2.5 – 21.2 %). Preoperative neurological deficits were more common in the cervical compared to the thoracic (p < 0.01) and lumbar (p = 0.02) subgroups. No significant differences were observed regarding neurological improvement (p = 0.1) and complications (p = 0.6) among subgroups. Infection recurrence occurred in 4 patients (2.9 %), and 7 patients required revision (5 %). Subgroup analysis by cage type revealed no differences in preoperative neurological deficits (p = 0.1), neurological improvement (p = 0.9), and complications (p = 0.9).

Conclusions

This meta-analysis demonstrated high rates of neurological improvement, and low risk of postoperative complications and revisions among VO patients undergoing corpectomy. These findings highlight the safety and effectiveness of corpectomy in managing medically refractory VO or VO with neurological compromise.