THE USE OF EXPANDABLE CAGES AND VENTROLATERAL LOCKING PLATES IN SEVERE SPINAL INFECTIONS
Meir AR, Hamady M, Akmal M
ST MARYS HOSPITAL,IMPERIALCOLLEGEHEALTHCARE NHS TRUST
Spinal infections are a significant cause of morbidity and mortality in both the developed and developing world. Epidemiological data suggests the incidence of pyogenic and mycobacterial infections is increasing in European countries. Less severe cases can be managed with antibiotics, bracing and careful observation. In severe infections, with neurological deficit, progressive deformity or uncontrolled sepsis, the mainstay of surgical management is debridement with or without stabilisation using anterior and posterior instrumentation. Recent developments in spinal instrumentation include in situ expandable cages and ventrolateral locking plates. We have used a construct consisting of an anterior expandable cage with a ventrolateral locking plate in destructive spinal infections.
14 Patients who had undergone surgical intervention for spinal infection were reviewed retrospectively for upto 2 years. Complications, post op systemic and neurological status were assessed. In those cases where a cage/ plate construct was used from an isolated anterior approach, post operative radiographs were analysed for implant stability, deformity correction and radiological fusion.
Good early results in terms of safety, resolution of pain, control of deformity and improvement of neurological deficits have been observed. Post operative radiological assessment showed the cages to be stable with time and further deformity progression was prevented. In one case of an elderly patient, vertebral body cement augmentation was required to prevent subsidence. There have been no cases of implant displacement or loosening.
Expandable cages with ventrolateral locking plates appear to provide satisfactory stable fixation from an isolated anterior approach in severe spinal infections. We have found the technique safe and have shown good short term results both clinically and radiologically. Further studies are required to show long term efficacy.