Case Report Turk Neurosurg 2014, Vol: 24, No: 4, 613-617 613 Received: 01.10.2013 / Accepted: 27.11.2013 DOI: 10.5137/1019-5149.JTN.9380-13.0 ABSTRACT AIM: To evaluate the feasibility of this novel surgical approach for treatment of cervical discitis and vertebral osteomyelitis. MATERIAL and METHODS: This is a report of two patients who underwent anterior cervical decompression for discitis and vertebral osteomyelitis (DVO) with cervical spine reconstruction with polymethylmethacrylate impregnated with antibiotics (AI-PMMA). RESULTS: Both patients had successful procedures that were followed by 6 weeks of intravenous antibiotics. Stabilization and eradication of infection was achieved with clinical and radiographic stabilization seen in both. Follow-up is greater than 18 months and both patients remain of antibiotics. CONCLUSION: The described technique using AI-PMMA ofers immediate structural stability and local delivery of high concentration of antibiotics. Use in two patients has demonstrated a cost efective, long-term biomechanically stable construct and infection control. KEYWORDS: Polymethylmethacrylate, Antibiotic, Cervical discitis, Cervical osteomyelitis, Anterior biomechanical device ÖZ AMAÇ: Servikal diskit ve vertebral osteomiyelit tedavisi için yeni bir cerrahi yaklaşımın uygulanabilirliğini değerlendirmek. YÖNTEM VE GEREÇLER: Bu rapor DVO için antibiyotik emdirilmiş polimetilmetakrilat (AI-PMMA) ile servikal vertebra rekonstrüksiyonu ile anterior servikal dekompresyon uygulanan iki hastayla ilgilidir. BULGULAR: Her iki hasta başarılı bir ameliyat geçirdi ve intravenöz antibiyotik ile 6 hafta takip edildi. Enfeksiyon stabilizasyonu ve eradikasyonu ile birlikte klinik ve radyografik stabilizasyon iki hastada da sağlandı. Takip 18 ayı geçmiştir ve şu anda iki hasta da antibiyotik kullanmamaktadır. SONUÇ: Tarif edilen AI-PMMA tekniği, hızlı yapısal stabilite ve yüksek bir antibiyotik konsantrasyonunun lokal iletimini sağlar. İki hastada maliyet etkinlik, uzun vadeli biyomekanik istikrarlı yapı ve enfeksiyon kontrolü elde edilmiştir. ANAHTAR SÖZCÜKLER: Polimetilmetakrilat, Antibiyotik, Servikal diskitis, Servikal osteomiyelit, Anterior biyomekanik cihaz Corresponding Author: Lee SANDQUIST / E-mail: sandql@hotmail.com Ryan J. BARRETT 1,2 , Lee SANDQUIST 1 , Boyd F. RICHARDS 1,2 , Teck M. SOO 1,2 1 Providence Hospital and Medical Centers, Department of Neurological Surgery, Southfield, MI, USA 2 Michigan Spine and Brain Surgeons, Southfield, MI, USA Antibiotic-Impregnated Polymethylmethacrylate as an Anterior Biomechanical Device for the Treatment of Cervical Discitis and Vertebral Osteomyelitis: Technical Report of Two Cases Servikal Diskitis ve Vertebral Osteomiyelit Tedavisinde Bir Anterior Biyomekanik Cihaz Olarak Antibiyotik Emdirilmiş Polimetilmetakrilat: İki Olgunun Teknik Raporu Case Report INTRODUCTION The treatment of discitis and vertebral osteomyelitis (DVO) remains a challenge. Options range from conservative management, including bracing and antibiotics, to aggressive debridement and primary reconstruction (1,11,13,24). Although gaining wider acceptance and support in the literature, the use of structural allografts and instrumentation in DVO remains controversial (1,18,22). This is primarily based on the perceived risk of persistent infection related to a devitalized graft and adjunctive use of spinal implants that in turn raises concerns of construct failure. The use of antibiotic-impregnated polymethylmethacrylate (AI-PMMA) has long been used in the orthopedic community for the treatment of osteomyelitis outside of the spine, specifcally in infected joints and long bones (8,12,16,25). A biomechanical device that ofers immediate stability and the local delivery of antibiotics provides an appealing option in the setting of DVO. This communication reports two patients who underwent anterior cervical decompression for DVO followed by reconstruction with polymethylmethacrylate impregnated with antibiotics (AI-PMMA).