tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 104

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 104. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Infections of the Spine Chapter 36 1033 Radical Debridement Radical debridement without bone grafting is sufficient in cases with predominant epidural abscess absence of significant vertebral or intradiscal involvement absence of gross bony destruction deformity and instability Radical debridement is the key to successful surgery Radical Debridement and Bone Grafting Radical debridement and bone grafting are indicated in patients with intraspinal abscesses without gross bony destruction deformity or instability There is still debate on the timing of the bone grafting. The main concern in primary bone grafting is the resolution of the graft by the infection. On the other hand secondary bone grafting requires reoperation with theoretically increased morbidity. In the absence of conclusive data in the literature the present author prefers primary bone grafting unless radical debridement is not achieved. In this case a second-look operation is imperative and depending on the local situation bone grafting is performed during the latter intervention. Primary bone grafting is preferred Radical Debridement Bone Grafting and Instrumentation Radical debridement and bone stable reconstruction of the spine are favored as the surgical technique of choice based on the good results obtained with surgical treatment of spinal tuberculosis 23 32 33 Table 5 Table 5. Rationales for radical debridement and stable reconstruction of the spine improvement of general condition after abscess drainage in early stages extirpation of infected focus is easy prevention of secondary deformity late recurrence is less frequent rapid progress of infection is prevented putative shorter hospitalization and earlier return to work While the use of spinal instrumentation in the presence of spinal infection has been controversial in the literature an increasing number of articles indicate that instrumentation is not contraindicated in cases where radical debridement is achieved 14 . There are no .