The data is tabulated in the table. Although most primary spinal infections can be treated non-operatively, there are situations where operative treatment becomes necessary. Our indications for surgery are neurologic compromise, intractable pain, structural instability or failure of non-operative management to prevent progressive bony destruction. These indications have been used for many years in dealing with tuberculous spondylitis. Primary reconstruction is also supported by several recent studies in pyogenic osteomyelitis of the spine.
Medical management is most likely to be successful in the host with an intact immune system.
The key to successful management remains taking adequate tissue samples to identify the infecting organism and allowing appropriate susceptibility testing. Only rough guidelines for medical management based on empirical data are available. Primary debridement and anterior bone grafting for treatment of tuberculous spondylitis was first reported by Ito et al in 1934. Later, Hodgson applied aggressive debridement and primary bone grafting in large numbers of patients. He was successful in altering the uniformly poor outcome of severe spinal tuberculosis with deformity.