Effects of Intervertebral Disc Infection on the Developing Ovine Spine

Walters, Rebecca; Smith, S.H.; Hutchinson, M. J.; Dolan, Anthony; Fraser, Robert D.; Moore, Robert J.

doi:10.1097/01.brs.0000164102.31726.0a

Cited by 8 publications

(5 citation statements)

References 22 publications

(32 reference statements)

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“…While iatrogenic discitis was once considered to be an aseptic condition there is now evidence that it results from the inadvertent introduction of bacteria during procedures that penetrate the intervertebral disc [2,17]. Infecting organisms initiate a sequence of inflammatory reactions that eventually lead to endplate destruction.…”

Section: Introductionmentioning

confidence: 99%

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

et al. 2006

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Infection can occur after any spinal procedure that violates the disc and although it is not common, the potential consequences are serious. Treatment of discitis is not always successful and the key to management is prevention. Intradiscal prophylaxis with antibiotic is routinely used in spinal surgery, but there is a limited understanding of how well antibiotics can enter the avascular disc after intravenous injection. An in vivo ovine study to optimise prophylactic and parenteral treatment of discitis is described to assess the effectiveness of cephazolin in preventing and treating infection. The concentration of cephazolin was measured in disc tissue from normal and degenerate sheep discs to determine if cephazolin can enter the disc and if disc degeneration affects antibiotic uptake. Fourteen sheep were deliberately inoculated with bacteria to induce discitis. Eight sheep ("prophylaxis" group) were given either a 0, 1, 2 or 3 g dose of prophylactic cephazolin before inoculation while the remaining sheep ("treatment" group) were treated with cephazolin commencing 7 days after inoculation for 21 days at a dose of 50 mg/kg/day. Histopathology and radiography were used to assess the effect of the different treatments. Cephazolin was given 30 min prior to sacrifice and the intradiscal concentration was measured by biochemistry. In the "prophylaxis" group all doses of antibiotic provided some protection against infection, although it was not dose dependent. In the "treatment" group discitis was confirmed radiologically and histologically in all animals from 2 weeks onwards. Biochemical assay confirmed that antibiotic is distributed throughout the disc but was present in higher concentration in the anulus fibrosus than the nucleus pulposus. This study demonstrated that whilst the incidence of iatrogenic discitis can be reduced by antibiotic prophylaxis, it could not be abolished in all incidences with a broad-spectrum antibiotic such as cephazolin. Furthermore, antibiotics were ineffective at preventing endplate destruction once an intradiscal inoculum was established.

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Section: Introductionmentioning

confidence: 99%

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

et al. 2006

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“…52 Fraser et al described the first animal model of discitis by direct inoculation into the sheep IVD to investigate the efficacy of IV antibiotics in 1989. 53,54 This study demonstrated the value of prophylactic antibiotics in effectively preventing infectious discitis; however, antibiotic treatment was not sufficient to eliminate an established S. epidermidis infection, highlighting the limitations of antibiotic therapies alone. A further ovine model of discitis, using direct intradiscal inoculation by S. aureus describes similar resulting infection.…”

Section: Ovine Modelsmentioning

confidence: 94%

“…Large‐animal models have advantages over small‐animal models in the study of spine disease as they have more relevant anatomy, allow for easy IV access for antibiotic administration and support clinically relevant instrumentation 52 . Fraser et al described the first animal model of discitis by direct inoculation into the sheep IVD to investigate the efficacy of IV antibiotics in 1989 53,54 . This study demonstrated the value of prophylactic antibiotics in effectively preventing infectious discitis; however, antibiotic treatment was not sufficient to eliminate an established S. epidermidis infection, highlighting the limitations of antibiotic therapies alone.…”

Section: Models Of Spinal Infectionsmentioning

confidence: 99%

“…While prophylactic antibiotics effectively inhibited infection establishment, antibiotic treatment of preexisting infection failed to arrest the progression of discitis 53 . Similarly, Walters et al failed to abolish established discitis with the antibiotic, cefazolin 54,55 . Guiboux et al examined the effect of prophylactic antibiotic use in their rabbit model of iatrogenic IVD infections 42 .…”

Section: Model Suitability For Investigating Treatment Strategiesmentioning

confidence: 99%

“…53 Similarly, Walters et al failed to abolish established discitis with the antibiotic, cefazolin. 54,55 Guiboux et al examined the effect of prophylactic antibiotic use in their rabbit model of iatrogenic IVD infections. 42 In this seminal study, IV cefazolin or vancomycin effectively prevented postoperative discitis in S. aureus inoculated IVD.…”

Section: Efficacy Of Antibiotic Therapymentioning

confidence: 99%

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Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design

2021

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Spine-related infections, such as vertebral osteomyelitis, discitis, or spondylitis, are rare diseases that mostly affect adults, and are usually of hematogenous origin. The incidence of this condition has gradually risen in recent years because of increases in spine-related surgery and hospital-acquired infections, an aging population, and intravenous (IV) drug use. Spine infections are most commonly caused by Staphylococcus aureus, while other systemic infections such as tuberculosis and brucellosis can also cause spondylitis. Various animal models of vertebral osteomyelitis and associated infections have been investigated in mouse, rat, chicken, rabbit, dog, and sheep models by hematogenous and direct inoculation in surgery, each with their strengths and limitations. This review is the first of its kind to concisely analyze the various existing animal models used to reproduce clinically relevant models of infection. Spine-related infection models must address the unique anatomy of the spine, the avascular nature of its structures and tissues and the consequences of tissue destruction such as spinal cord compression. Further investigation is necessary to elucidate the specific mechanisms of host-microbe response to inform antimicrobial therapy and administration techniques in a technically demanding body cavity. Small-animal models are not suitable for large instrumentation, and difficult IV access thwarts antibiotic administration. In contrast, large-animal models can be implanted with clinically relevant instrumentation and are resilient to repeat procedures to study postoperative infection. A canine model of infection offers a unique opportunity to design and investigate antimicrobial treatments through recruitment a rich population of canine patients, presenting with a natural disease that is suitable for randomized trials.

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Diskitis

Hong¹,

Gutierrez²

2018

Principles and Practice of Pediatric Infectious Diseases

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Effects of Intervertebral Disc Infection on the Developing Ovine Spine

Abstract: Infection of juvenile ovine discs impedes disc development but has no significant effect on vertebral body growth.

Cited by 8 publications

References 22 publications

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design

Diskitis

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