Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use

Abstract

Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens. VO can be devastating, as infection can result in pathogenic biofilms on instrumentation that is dangerous to remove. New techniques, such as kyphoplasty and novel vertebroplasty methods, could amplify the potential of ABC in spine surgery. However, caution should be exercised when using ABC as there is some evidence of toxicity to patients and surgeons, antibiotic allergies, bone cement structural impairment, and possible development of antibiotic resistance. The purpose of this article is to describe the basic science of antibiotic cement utilization and review its usage in spine surgery.

Multifunctional magnesium-organic framework doped biodegradable bone cement for antibacterial growth, inflammatory regulation and osteogenic differentiation

“…53,54 Antibiotics had the potential to cause cytotoxicity, and overusing them increased the risk of developing antibiotic resistance, which reduced their effectiveness against bacteria. [55][56][57] The Mg-MOF bone cement not only possessed remarkable antibacterial properties, but it could encourage osteoblast proliferation and differentiation when compared to the addition of antibiotics such as vancomycin, tobramycin and gentamicin to conventional cement. 58…”

Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study

“…Despite preventive efforts, spinal fusion surgery may still result in spinal infection in a certain percentage of patients, which may require further procedures (such as revision surgery and removal of spinal fixation devices, as well as the insertion of new devices) if conservative treatment with antibiotics is not effective [34,35]. If infection cannot be effectively controlled even with revision surgery, multiple extensive and repeated operations may be required, resulting in decreased patient quality of life, increased financial burden for the family, and even catastrophic outcomes, such as patient death [36,37]. These issues also increase societal costs.…”

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.…”