Kumu Cloward Lecture, Instrumentation for the treatment of spinal infection

Abstract

To commemorate twentieth anniversary of Kumu Cloward Lecture, the birth history of the lecture was introduced and the lecture was delivered to review instrumentation for the treatment of spinal infection, specifically to show our experience on two-staged (PI-A) surgery. Anterior debridement and reconstruction with bone graft is a gold standard for surgical treatment of vertebral osteomyelitis. However, it was described "Open the gate of death" to perform anterior debridement and fusion before the appearance of antibiotics. It was after antibiotics that anterior surgery become popular. In modern era of antibiotic resistant bacteria, it seems to be as dangerous as pre-antibiotic era to perform anterior surgery. By analogy with the pre-antibiotic era, we performed posterior spinal instrumentation as the first stage operation, and then performed anterior surgery as the second operation. In 1997, we began to use a two-stage surgical treatment (first: posterior instrumentation; second: anterior debridement and bone graft). The advantages of this method is dual: surgical morbidity is divided and surgical effect is immediate. After the first procedure (posterior instrumentation), the patient is entertained with decrease of pain and is able to sit up from bed rest. Moreover, erythrocyte sedimentation rate (ESR) decreases after posterior stabilization and without drainage of anterior focus. This method is especially effective for thoracolumbar spondylitis of the patients with poor general conditions.