Two cases of posterior spinal fixation with titanium mesh cage and fenestrated pedicle screw for pyogenic spondylitis

Pyogenic spondylitis in older patients with osteoporosis presents significant challenges due to implant failure and comorbidities. This study reports two cases of osteoporotic pyogenic spondylitis with substantial bony destruction, treated with cement-augmented pedicle screws (CAPS) and titanium mesh cages (TMC). Both patients achieved complete eradication of infection, spinal stabilization, and favorable clinical outcomes without recurrence or implant failure during follow-up. Patient 1 underwent posterior percutaneous pedicle screw fixation combined with CAPS and interbody fusion using a TMC via a costovertebral approach, whereas Patient 2 involved posterior vertebral body resection with TMC and CAPS to prevent cage subsidence. CAPS enhanced screw fixation and minimized complications related to poor bone quality. To our knowledge, this is the first report on the use of CAPS in the treatment off pyogenic spondylitis. The combined use of CAPS and TMC may offer a promising strategy for managing osteoporotic pyogenic spondylitis with extensive bony destruction.