Antibiotic-loaded calcium sulfate beads in spinal surgery for patients with spondylodiscitis: a clinical retrospective study

Abstract

Background Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after debridement using the Quadrant channel combined with percutaneous fixation through a single-stage posterolateral approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods This study collected the data of 32 patients with spine spondylodiscitis and was surgically treated in our department from July 2015 to August 2020. The Demographic data included age, gender, involved segment, and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65% to 10%. Cobb angle was significantly improved and could be maintained at final follow-up. New bone formation was observed in all patients. There were no recurrences of infection in our study. Conclusions The posterolateral debridement and percutaneous fixation combined with antibiotic-loaded calcium sulfate beads filling are effective in the treatment of spondylodiscitis in terms of infection control, early mobilization, and recovery.

Vacuum assisted closure and local drug delivery systems in spinal infections: A review of current evidence

“… [22] also described the use of a PMMA strut graft as the LDDS in treatment of patients with spinal osteomyelitis. Gentamicin, tobramycin, vancomycin, and clindamycin are the most widely used in ABC [20 , 57] . Gentamicin and tobramycin covers for gram negative bacteria whereas vancomycin and clindamycin covers for gram positive bacteria.…”

“…Tang et al. [20] used a mixture of ABC with 0.5 g of vancomycin hydrochloride with cefoperazone and sulbactam sodium for both gram positive and gram-negative coverage respectively. In their study, antibiotic loaded calcium sulfate beads were described to be safe in managing spondylodiscitis.…”

“…The VAC system has also demonstrated the ability to be used for infection prophylaxis, reducing the incidence of SSIs by up to 50% after application for closed incisions [19] . There also have been demonstrations of the use of LDDS such as antibiotic cement either in the form of beads [20 , 21] or a strut graft [22] and the use of Closed Suction Irrigation Systems (CSIS), with or without drug delivery, to assist in the successful management of SSIs [23] .…”

Utilization of Antibiotic Bone Cement in Spine Surgery: Pearls, Techniques, and Case Review

“…Recent studies have demonstrated this technique to be effective in treating spinal surgical site infections. 15,16…”