Use of femoral head allografts in the treatment of nonspecific spondylodiscitis of the thoracic and lumbar spine

Objective. To analyze clinical and radiological results of two-stage surgical treatment of nonspecific spondylodiscitis with anterior debridement of the infection site and corporodesis using a container-type titanium implant filled with allograft material obtained from the femoral heads during primary endoprosthetics.

Material and Methods. A retrospective single-center study initially included 31 patients with spinal infection. After exclusion of two cases of tuberculous spondylodiscitis, the final study cohort consisted of 29 patients (13 men, 16 women; mean age – 64.7 years) with nonspecific spondylodiscitis of the thoracic and lumbar spine who underwent surgery between 2017 and 2022. All patients underwent a two-stage surgical intervention: anterior debridement of the lesion with placement of a titanium cylindrical cage filled with allobone material, followed by posterior transpedicular fixation. The minimum follow-up period was 18 months (mean 27.7 months). Clinical parameters (VAS, Frankel scale, MacNab scale), laboratory inflammatory markers, and the quality of bone fusion according to the Tan classification were assessed.

Results. The mean preoperative VAS pain score was 7.9; it decreased to 4.5 at discharge and to 1.9 at 18 months postoperatively (p < 0.001). Neurological improvement was observed in 14 (66.7%) of 21 patients with preoperative deficits, and complete regression in 8 (38.1%) patients. Radiographic assessment showed Grade I–II bone fusion according to Tan in 93.5% of patients. No cases of pseudoarthrosis or implant migration were observed. Excellent and good functional outcomes according to the MacNab scale were achieved in 83.8% of patients. Early infectious complications in the anterior approach area occurred in 9.7% of cases and were successfully managed with staged surgical treatment and VAC therapy. No generalized infection, implant removal, or deaths were recorded.

Conclusion. The use of allogeneic femoral head bone grafting in the treatment of nonspecific spondylodiscitis as part of a two-stage surgical approach provides reliable spinal segment stabilization, solid bone fusion, and significant clinical improvement. This method has demonstrated high efficacy and safety, and represents a valuable alternative to autografts, particularly in debilitated patients.

1. Duarte RM, Vaccaro AR. Spinal infections: state of the art and management algorithm. Eur Spine J. 2013;22:2787–2799. DOI: 10.1007/s00586-013-2850-1

2. Pola E, Logroscino CA, Gentiempo M, Colangelo D, Mazzotta V, Di Meco E, Fantoni M. Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:35–49.

3. Базаров А.Ю., Сергеев К.С., Цветкова А.К. Отдаленные результаты и оценка эффективности методов лечения остеомиелита позвоночника при различных типах поражений по классификации E. Pola. Травматология и ортопедия России. 2023;29(2):7–17. [Bazarov AYu, Sergeev KS, Tsvetkova AK. Long-term outcomes and effectiveness of treatment methods for vertebral osteomyelitis with different types of lesions according to the E. Pola Classification. Traumatology and Orthopedics of Russia. 2023;29(2):7–17]. DOI: 10.17816/2311-2905-7445 EDN: LCSXMA

4. Tuchman A, Pham M, Hsieh PC. The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm. Neurosurg Focus. 2014;37:E8. DOI: 10.3171/2014.6.FOCUS14261

5. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine. 2006;31:2695–2700. DOI: 10.1097/01.brs.0000244662.78725.37

6. Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, Kanj SS. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3:5–16. DOI: 10.1016/j.jiph.2010.01.001

7. Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Osmon DR. Do follow-up imaging examinations provide useful prognostic information in patients with spine infection? Clin Infect Dis. 2006;43:172–179. DOI: 10.1086/505118

8. Homagk L, Marmelstein D, Homagk N, Hofmann GO. SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system. J Orthop Surg Res. 2019;14:100. DOI: 10.1186/s13018-019-1134-9

9. Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J. 2010;19:575–582. DOI: 10.1007/s00586-009-1216-1

10. Aagaard T, Roed C, Dahl B, Obel N. Long-term prognosis and causes of death after spondylodiscitis: a Danish nationwide cohort study. Infect Dis (Lond). 2016;48(3): 201–208. DOI: 10.3109/23744235.2015.1103897

11. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res. 2006;444:27–33. DOI: 10.1097/01.blo.0000203452.36522.97

12. Мушкин А.Ю., Вишневский А.А., Перецманас Е.О., Базаров А.Ю., Басанкин И.В. Инфекционные поражения позвоночника: проект национальных клинических рекомендаций. Хирургия позвоночника. 2019;16(4):63–76. [Mushkin AYu, Vishnevsky AA, Peretsmanas EO, Bazarov AYu, Basankin IV. Infectious lesions of the spine: draft national clinical guidelines. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2019;16(4):63–76]. DOI: 10.14531/ss2019.4.63-76 EDN: KUOPMM

13. Бывальцев В.А., Степанов И.А., Борисов В.Э., Калинин А.А., Плешко И.В., Белых Е.Г., Алиев М.А. Инфекции в области хирургического вмешательства в спинальной нейрохирургии. Казанский медицинский журнал. 2017;98(5):796–803. [Byval’tsev VA, Stepanov IA, Borisov VE, Kalinin AA, Pleshko IV, Belykh EG, Aliev MA. Surgical site infections in spinal neurosurgery. Kazan Medical Journal. 2017;98(5):796–803]. DOI: 10.17750/KMJ2017-796 EDN: ZGSBGN

14. Клинические рекомендации «Воспалительные поражения позвоночника». Ассоциация травматологов-ортопедов России, Российская ассоциация хирургов-вертебрологов, Национальная ассоциация фтизиатров и др., 2024. Доступно в реестре клинических рекомендаций Минздрава РФ: https://cr.minzdrav.gov.ru [Clinical guidelines “Inflammatory lesions of the spine”. The Association of Orthopedic Traumatologists of Russia, the Russian Association of Vertebrology Surgeons, the National Association of Phthisiologists, etc., 2024. Available in the register of clinical recommendations of the Ministry of Health of the Russian Federation: https://cr.minzdrav.gov.ru].

15. Lener S, Hartmann S, Barbagallo GMV, Certo F, Thome C, Tschugg A. Management of spinal infection: a review of the literature. Acta Neurochir (Wien). 2018;160:487–496. DOI: 10.1007/s00701-018-3467-2

16. Sobottke R, Seifert H, Fätkenheuer G, Schmidt M, Gossmann A, Eysel P. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int. 2008;105:181–187. DOI: 10.3238/arztebl.2008.0181

17. Govender S. Spinal infections. J Bone Joint Surg Br. 2005;87:1454–1458. DOI: 10.1302/0301-620X.87B11.16294

18. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;329:300–309. DOI: 10.1097/00003086-199608000-00037

19. Kim SS, Kang DH, Yoon JW, Park H, Lee CH, Hwang SH. Surgical treatment of pyogenic spondylitis with the use of freeze-dried structural allograft. Korean J Spine. 2014;11(3):136–140. DOI: 10.14245/kjs.2014.11.3.136

20. Chung TC, Yang SC, Chen HS, Kao YH, Tu YK, Chen WJ. Single-stage anterior debridement and fibular allograft implantation followed by posterior pedicle screw instrumentation for complicated infectious spondylitis: report of 20 cases. Medicine (Baltimore). 2014;93(27):e190. DOI: 10.1097/MD.0000000000000190

21. Martínez-Gutiérrez O, Peña-Martínez V, Camacho-Ortiz A, Vilchez-Cavazos F, Simental-Mendía M, Tamez-Mata Y, Acosta-Olivo C. Spondylodiscitis treated with freeze-dried bone allograft alone or combined with autograft: A rando-mized and blinded trial. J Orthop Surg (Hong Kong). 2021;29(2):23094990211019101. DOI: 10.1177/23094990211019101

22. Placide R., Reznicek J. Evaluation and management of pyogenic spondylodiscitis: a review. J Clin Med. 2025;14(10):3477. DOI: 10.3390/jcm14103477

23. Hijazi MM, Siepmann T, Disch AC, Platz U, Juratli TA, Eyüpoglu IY, Podlesek D. Diagnostic sensitivity of blood culture, intraoperative specimen, and computed tomography-guided biopsy in patients with spondylodiscitis and isolated spinal epidural empyema requiring surgical treatment. J Clin Med. 2023;12:3693. DOI: 10.3390/jcm12113693

24. Беллендир Э.Н. Особенности восстановительных процессов при пластическом замещении костных полостей после удаления туберкулезных очагов в эксперименте: автореф. дис. … д-ра мед. наук. Ленинград, 1968. [Bellendir EN. Features of restorative processes in plastic replacement of bone cavities after removal of tuberculous foci in an experiment: Abstract of a doctor of medical sciences dissertation. Leningrad, 1968]. URL: https://rusneb.ru/catalog/000199_000009_005964247/

25. Беллендир Э.Н., Салмагамбетов И.У. Способы применения компонентной аллопластики в костно-суставной хирургии. Вестник хирургии им. И.И. Грекова. 1990;144(10):87–91. [Bellendir EN, Salmagambetov IU. Theoretical substantiation of using the component plastic surgery in osteoarticular surgery. Grekov’s Bulletin of Surgery. 1990;144(10):87–91].

26. Бояркина С.К. Репаративная регенерация кости, васкуляризация и костная пластика при туберкулезной, стафилококковой и смешанной инфекциях. Проблемы туберкулеза. 1981;(9):54. [Boyarkina SK. Reparative bone regeneration, vascularization, and bone grafting in tuberculosis, staphylococcal, and mixed infections. Problemy Tuberkuleza. 1981;(9):54].

27. Гусева В.Н., Гарбуз А.Е. Исходы декомпрессивных операций у больных туберкулезным спондилитом. Проблемы туберкулеза. 2001;(9):47–51. [Guseva VN, Garbuz AE. Results of decompression operations in patients with tuberculous spondylitis. Problemy Tuberkuleza. 2001;(9):47–51].

28. Цивьян Я.Л., Рамих Э.А., Михайловский М.В. Репаративная регенерация тела сломанного позвонка. Новосибирск, 1985. [Tsivyan YaL, Ramikh EA, Mikhaylovskiy MV. Reparative Regeneration of the Fractured Vertebral Body. Novosibirsk, 1985]. URL: https://rusneb.ru/catalog/000199_000009_001262274/

29. Летина В.К., Ардашев И.П. Применение костной аллотрансплантации при реконструктивных операциях на позвоночнике. Ортопедия, травматология и протезирование. 1986;(4):12–18. [Letina VK, Ardashev IP. Use of bone allotransplantation in reconstructive operations on the spine. Orthopedics, Traumatology and Prosthetics. 1986;(4):12–18].

30. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002;34:1342–1350. DOI: 10.1086/340102

31. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine. 2000;25:1668–1679. DOI: 10.1097/00007632-200007010-00010

32. von Stechow D, Rauschmann MA. Effectiveness of combination use of antibioticloaded PerOssal with spinal surgery in patients with spondylodiscitis. Eur Surg Res. 2009;43:298–305. DOI: 10.1159/000233525

33. Tang X, Li J, Wang C, Liu F, Guo J, Tan J, Song Q, Cao H, Zhang Y. Antibioticloaded calcium sulfate beads in spinal surgery for patients with spondylodiscitis: a clinical retrospective study. BMC Musculoskelet Disord. 2022;23:270. DOI: 10.1186/s12891-022-05230-y

34. Funayama T, Noguchi H, Shibao Y, Sato K, Kumagai H, Miura K, Takahashi H, Tatsumura M, Koda M, Yamazaki M. Unidirectional porous beta-tricalcium phosphate as a potential bone regeneration material for infectious bony cavity without debridement in pyogenic spondylitis. J Artif Organs. 2023;26:89–94. DOI: 10.1007/s10047-022-01335-2

35. Deml MC, Cattaneo EN, Bigdon SF, Sebald HJ, Hoppe S, Heini P, Benneker LM, Albers CE. PMMA-Cement-PLIF is safe and effective as a single-stage posterior procedure in treating pyogenic erosive lumbar spondylodiscitis-a single-center retrospective study of 73 cases. Bioengineering (Basel). 2022;9:73. DOI: 10.3390/bioengineering9020073