Only 6 cases of pyogenic
spondylitis following
vertebroplasty or
kyphoplasty have been reported, and their causes remained unclear. The authors report on 4 cases of delayed pyogenic
spondylitis (DPS) following
vertebroplasty or
kyphoplasty for osteoporotic
compression fractures and metastatic disease. Four patients presented with DPS after
vertebroplasty or
kyphoplasty and underwent surgical treatment. Clinical history, laboratory examination, and MR imaging confirmed the diagnosis of DPS. Anterior
debridement, reconstruction, and posterior instrumented fusion were performed. The mean interval for the delayed occurrence of pyogenic
spondylitis after surgery was 12.3 months. The
infections were primarily bacterial in origin, but most patients also suffered diverse medical comorbidities. Despite successful treatment of the
infections, comorbidity was and is
a factor that compromises good results. Medical comorbidities associated with compromised immunity may increase susceptibility to DPS after
vertebroplasty or
kyphoplasty. In cases of incapacitating
back pain after a
pain-free period following either of these surgeries, evaluation of the erythrocyte sedimentation rate and
C-reactive protein level and examination of contrast-enhanced MR imaging studies are essential to rule out delayed vertebral
infection. Surgical treatment requires cement removal and anterior reconstruction with or without additional posterior instrumented fusion.