Study on the causes of infection after percutaneous vertebroplasty and the treatment of posterior surgery
Authors: xie banglin , li Yun-Cong , guo Run-sheng , Xu Tian-tian , Ai Qiu-xiao , Zhang Bin 
Published: April 2024

Background

To conduct a retrospective study on patients who developed infections after vertebral augmentation procedures, analyzing the causes of post-procedural infections, evaluating the efficacy of posterior fixation surgeries, and determining whether complete removal of bone cement is necessary. This study aims to provide valuable insights for the clinical prevention of infections following vertebral augmentation procedures.

PURPOSE

A retrospective study was conducted on 30 patients with post-vertebral body reconstruction infections following vertebral augmentation procedures from January 2016 to April 2023 among 3817 PVP patient. . The aim was to analyze the preoperative clinical characteristics of post-vertebral body reconstruction infections, assess the effectiveness of posterior approach surgeries, and determine the necessity of complete removal of bone cement. The findings aim to provide insights for the clinical prevention and treatment of post-vertebral body reconstruction infections.

STUDY DESIGN

Retrospective clinical study

PATIENT SAMPLE

Consecutive series of 30 patients at a single hospital

Outcome measures

The study aims to investigate the variance in clinical efficacy between conservative and surgical treatments, the necessity of bone cement removal during surgical intervention, the potential of achieving clinical cure without bone cement removal in cases of non-specific spondylitis and spinal tuberculosis, and to evaluate postoperative living ability using the ODI score.
METHODS
We included 30 cases of post-vertebral augmentation procedure infections (PvP) rom January 2016 to April 2023 among 3817 PVP patient. . The study aimed to investigate whether there was a difference in clinical efficacy between patients who had bone cement removed during surgical treatment and those who did not. We specifically examined whether non-specific spinal infections and spinal tuberculosis could both achieve clinical cure without removing bone cement, using the Oswestry Disability Index (ODI) to assess postoperative functional abilities. Data analysis was performed using SPSS version 25.0 software. Normally distributed continuous variables were presented as mean ± standard deviation (x± s) and compared using independent sample t-tests. Categorical data were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square test. Statistical significance was set at P < 0.05.
RESULTS
In this study, we collected data from 30 cases of post-vertebroplasty (PVP) infection. There were 22 cases in the surgical group, including one patient who underwent surgery after strict conservative treatment failure. Among the surgical group, 21 cases underwent posterior approach surgeries for lesion debridement and vertebral augmentation, with 8 cases retaining bone cement (3 cases of tuberculosis, 5 cases of non-specific infection) and 11 cases completely removing bone cement. Two cases died within 6 months after surgery, and one case underwent posterior approach fixation alone. The conservative treatment group comprised 8 cases, with one death occurring 6 months after treatment. Except for the deceased patients, all others achieved clinical cure. The mortality rates were not statistically different between the surgical group (91%) and the conservative treatment group (75%). The ODI scores for post-operative infection were significantly lower in the posterior approach surgery group (mean: 17.55) compared to the conservative treatment group (mean: 45), with a statistically significant difference (P<0.05). However, there was no statistically significant difference in ODI scores between the subgroup that removed bone cement (mean: 18.0) and the conservative group that retained bone cement (mean: 17.1). For patients with post-PVP infections (whether tuberculosis or non-specific inflammation), infection resolution was achievable with vertebral augmentation and fixation procedures, regardless of complete bone cement removal. Moreover, there was no statistically significant difference in postoperative ODI scores between the groups.
CONCLUSION
Before undergoing PVP surgery, it is crucial to actively treat infections in other parts of the body. Following a PVP infection, performing posterior approach surgeries for lesion debridement and vertebral augmentation leads to clinical cure, whether the infection is non-specific spinal infection or spinal tuberculosis. Even when complete removal of bone cement is challenging, clinical cure can still be achieved.