Article
Does antibiotics therapy prevent recurrent screw loosening after low-virulent colonialisation? A prospective observational study
Verhindert die antibiotische Therapie eine erneute Schraubenlockerung nach initialer aseptischer Schraubenlockerung und mikrobiologischer Besiedlung? Eine prospektive Beobachtungsstudie
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Authors
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Dimitri Tkatschenko
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Julia Onken
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Vincent Prinz
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Tobias Finger
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Andrej Trampuz
- Charité Universitätsmedizin, CMSC, Berlin, Deutschland
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Peter Vajkoczy
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Simon Bayerl
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Screw loosening after spondylodesis represents a common postoperative complication after spine surgery with heavy burden on both patients and healthcare stakeholders. Low-virulent microorganism colonialization exposed by sonication was identified as a possible cause for symptomatic implant ease. However, the role of antibiotics administration for de novo screw loosening prevention remains unclear. The aim of our study was to determine whether antibiotics administration after positive sonication prevents de novo screw loosening.
Methods: After positive ethics vote (EA2/047/19) all patients from January 2015 – July 2018 were identified undergoing revision surgery and examination of explanted screws for microorganism colonialization with sonication. All identified patients were invited for clinical and radiographic follow-up. Screw loosening was evaluated in CT-scans carried out at least 12 months after revision surgery. Subdivision into three groups was conducted: Group 1a included all patients with positive sonication results and postoperative antibiotics treatment, Group 1b involved all patients with positive sonication results without postoperative antibiotics treatment and Group 2 served as reference cohort containing all patients with negative sonication results.
Results: 79 patients (51 female, mean age 65.12 years) were identified. 25 patients agreed to participate in follow-up (31.6%). Eligible CT-scan for screw loosening evaluation was available in 42 patients (51.2%). This patient population was segregated into the three groups (Group 1a - n=5, 12%, Group 1b - n=8, 19% and Group 2 - n=29, 69%). In 10 out of 13 patients with positive sonication (Group 1a + Group 1b) de novo screw loosening occurred (76.9%) whereas antibiotics administration had no influence on screw loosening rates (4 out of 5 patients in Group 1a and 6 out of 8 patients in Group 1b). In the reference Group 2 in 11 out of 29 patients de novo screw loosening was identified (37.9%).
Conclusion: Low-virulent microorganism colonialization plays an important role in the incidence of screw loosening. No benefit for antibiotics administration in patients with positive sonication could be depicted. New ways of biofilm formation prevention have to be established.
