Antibiotic prophylaxis in surgery of the intervertebral disc

Abstract

Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy. Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.

Signalment and clinical features of diskospondylitis in dogs: 513 cases (1980–2001)

“…Empiric antimicrobial treatment in humans often includes a β-lactam drug combined with an aminoglycoside or fluoroquinolone drug. 47,48 In dogs, empiric treatment most often includes only first-generation cephalosporins. 9 High doses of cephalosporin drugs are needed to achieve therapeutic concentrations in the normal disk space.…”

“…9 High doses of cephalosporin drugs are needed to achieve therapeutic concentrations in the normal disk space. 48,49 Treatment recommendations should be amended as results of susceptibility testing become available. In dogs that do not respond to initial antimicrobial treatment, magnetic resonance imaging of the affected IVD should be considered to rule out abscessation.…”

Intervertebral disc homeostasis at normal conditions and during pathology

“…Отмечено, что скорость обменных процессов в межпозвонковом диске животных существенно снижается в период их полового созревания. В многочисленных экспериментах установлено, что интенсивность обменных процессов в дисках зависит от их формы и прилагаемой нагрузки [4,26].…”