Ehab Shiban1,2, Ann-Kathrin Joerger1, Insa Janssen3, Mohammed Issa1, Nicole Lange1, Arthur Wagner1, Susanne Feihl4, Florian Ringel5, Bernhard Meyer1. 1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany. 2. Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany. 3. Department of Neurosurgery, Hopitaux Universitaires Genève, Switzerland. 4. Department of Microbiology, Klinikum rechts der Isar, Technical University, Munich, Germany. 5. Department of Neurosurgery, Universitätsklinikum Mainz, Germany.
Abstract
BACKGROUND: Spinal instrumentation can be associated with complications, including implant loosening. Hitherto, implant loosening has mainly been attributed to mechanical overload. OBJECTIVE: To examine the role of low-grade infections as the cause of implant failure in suspected aseptic implant loosening following spinal instrumentation. METHODS: A prospective single center observational study was performed. All patients who had revision surgery following spinal instrumentation between August 2015 and February 2018 were screened. Patients with revision surgery due to screw loosening on the computed tomograhy scan constituted the study group. Patients in which the screws where not loosened but removal was performed for other reasons formed the comparison group. Intraoperative swabs were taken and sonication was performed with the explanted material. Results of microbiological cultivation were analyzed. RESULTS: A total of 59 patients were included in the study group and 34 in the comparison group. In the study group in 42.4% of the cultures a bacterium was detected, while in the comparison group only in 17.6%. 84%, and 83.3% of these germs were detected by sonication in the study and comparison group, respectively. The rate of positive cultures was significantly higher in the study group compared to the comparison group (P = .001). The most frequent bacterium cultivated in both groups was Propionibacterium acnes, followed by Staphylococcus species. CONCLUSION: For patients with screw loosening a high level of suspicion for a low-grade infection should be raised. Cultures should be performed from the sonication fluid of the explanted devices in all patients with symptomatic screw loosening.
BACKGROUND: Spinal instrumentation can be associated with complications, including implant loosening. Hitherto, implant loosening has mainly been attributed to mechanical overload. OBJECTIVE: To examine the role of low-grade infections as the cause of implant failure in suspected aseptic implant loosening following spinal instrumentation. METHODS: A prospective single center observational study was performed. All patients who had revision surgery following spinal instrumentation between August 2015 and February 2018 were screened. Patients with revision surgery due to screw loosening on the computed tomograhy scan constituted the study group. Patients in which the screws where not loosened but removal was performed for other reasons formed the comparison group. Intraoperative swabs were taken and sonication was performed with the explanted material. Results of microbiological cultivation were analyzed. RESULTS: A total of 59 patients were included in the study group and 34 in the comparison group. In the study group in 42.4% of the cultures a bacterium was detected, while in the comparison group only in 17.6%. 84%, and 83.3% of these germs were detected by sonication in the study and comparison group, respectively. The rate of positive cultures was significantly higher in the study group compared to the comparison group (P = .001). The most frequent bacterium cultivated in both groups was Propionibacterium acnes, followed by Staphylococcus species. CONCLUSION: For patients with screw loosening a high level of suspicion for a low-grade infection should be raised. Cultures should be performed from the sonication fluid of the explanted devices in all patients with symptomatic screw loosening.
Authors: Maximilian T Löffler; Nico Sollmann; Egon Burian; Amirhossein Bayat; Kaywan Aftahy; Thomas Baum; Bernhard Meyer; Yu-Mi Ryang; Jan S Kirschke Journal: Front Endocrinol (Lausanne) Date: 2021-01-11 Impact factor: 5.555
Authors: Daniel Dubinski; Sae-Yeon Won; Svorad Trnovec; Kseniya Gounko; Peter Baumgarten; Philipp Warnke; Daniel Cantré; Bedjan Behmanesh; Joshua D Bernstock; Thomas M Freiman; Florian Gessler; Steffen Sola Journal: Front Neurol Date: 2022-09-23 Impact factor: 4.086