Management of spinal osteomyelitis-associated deformity

Spinal osteomyelitis predominantly affects the anterior vertebral column. Pyogenic infection seldom results in significant deformity but rather the more insidious causes such as tuberculosis. The typical deformity is a single plane kyphosis, other than when the infection affects the more mobile and more loaded lumbar spine where facet subluxation may result in a three-dimensional torsional deformity. Management is dictated by whether the disease process is active versus healed disease, the skeletal maturity of the patient and whether there is ongoing spinal growth expected and associated neurological deficit. Surgical strategies may be anterior only, such as in the sub-axial cervical and thoracic active disease, combined anterior and posterior procedures at the cervico-thoracic and thoracic‐lumbar junctions, but the posterior circumferential vertebral column resection (VCR) is increasingly utilized for rigid healed disease, especially with late presenters and in those patients who have associated neurological impairment.