Reversal of tetraplegia in patients with cervical osteomyelitis - Epidural abscess using anterior debridement and fusion

Abstract

Objective: Aggressive anterior debridement and fusion has been advocated for the treatment of cervical osteomyelitis/epidural abscess (COEA) for many years. In this study we review our experiences with severely neurologically impaired (tetraplegic) patients with COEA. Methods: From 1989-1999 we identified 20 cases of COEA treated with anterior debridement and fusion. Patients were identified from a prospectively maintained database. All inpatient and outpatient records were reviewed. Six patients were identified as being tetraplegic prior to surgery. Tetraplegia was defined as complete absence or only flicker movement of the extremities. Results: The age range was 41 to 74. There were five men and one woman. Anterior corpectomy and fusion with either iliac crest auto- or allograft was performed in all patients. In four of six patients an anterior cervical plate was utilized for internal fixation. Four of six patients were ambulatory at last follow-up. Conclusion: Aggressive debridement and fusion in patients with COEA can result in successful outcomes even in patients who are tetraplegic prior to surgery.