1. Most cases of spondylodiscitis heal with antibiotic therapy, but large defects may be an indication for surgery.
2. After radical debridement of the affected vertebra, some authors prefer to fill the defect with autologous or allogeneic cancellous bone [18, 19], while others use titanium cages filled with bone grafts [20, 21], as was done in this series. Well-fitting spacers leading to evenly distributed load transmission between the spacer and the supporting vertebrae can provide immediate stability. PMMA cylinders provide such an equal load transmission, but they bear a high risk of dislocation. Harms cages achieve close contact between grafts and supporting bone, but anterior distraction is necessary before implant insertion, imposing an unfavourable load on the vertebral screws.
3. On the contrary, the Obelisc system is distractible in situ, and does not require the use of a supplementary distraction device. In situ distractibility was also seen as an advantage by Knop et al.
4. Moreover, the Obelisc cage has spikes, the importance of which was stressed by Morlock et al.
5. in a study on human cadaver specimens. Conclusions. One-stage surgical treatment for spondylodiscitis by antero-posterior surgical approach with posterior instrumentation and anterior reconstruction with vertebral body replacement device filled with composite antibiotic carrier is a feasible and effective method. In situ distractible vertebral body replacement systems allow for a stable customised restoration of the anterior column of the spine. Spikes prevent loosening of the cage. Bibliography.