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

Abstract

Vertebral osteomyelitis (VO) encompasses a spectrum of spinal infections ranging from isolated mild vertebral osteomyelitis to severe diffuse infection with associated epidural abscess and fracture. Although patients can often be treated with an initial course of intravenous antibiotics, surgery is sometimes required in patients with sepsis, spinal instability, neurological compromise, or failed medical treatment. Antibiotic bone cement (ABC) has been widely used in orthopedic extremity surgery for more than 150 years, both for prophylaxis and treatment of bacterial infection. However, relatively little literature exists regarding its utilization in spine surgery. This article describes ABC utilization in orthopedic surgery and explains the technique of ABC utilization in spine surgery. Surgeons can choose from multiple premixed ABCs with variable viscosities, setting times, and antibiotics or can mix in antibiotics to bone cements themselves. ABC can be used to fill large defects in the vertebral body or disc space or in some cases to coat instrumentation. Surgeons should be wary of complications such as ABC extravasation as well as an increased difficulty with revision. With a thorough understanding of the properties of the cement and the methods of delivery, ABC is a powerful adjunct in the treatment of spinal infections.

Triggered Release of Ampicillin from Metallic Implant Coatings for Combating Periprosthetic Infections

“…aureus alone. We first considered gentamicin and tobramycin, the broad-spectrum aminoglycoside antibiotic prophylaxis commonly blended in commercial bone cement to prevent infections following arthroplasty. − These broad-spectrum antibiotics work by disrupting bacterial protein synthesis via binding to the 30S ribosomal subunit. , The multiple primary amines present in gentamicin and tobramycin (Scheme A), however, pose a challenge for regioselective coupling with the carboxyl-terminated oligonucleotide linker. We then considered β-lactam broad-spectrum antibiotics that hinder bacterial cell wall synthesis by targeting penicillin-binding proteins (PBPs).…”