Minimizing the Surgical Approach in Patients with Spondylitis

Abstract

Minimizing the surgical approach in treating patients with spinal infections by using local antibiotic treatment and avoiding a ventral approach reduces the anesthesia and surgical risks in patients with comorbidities. In this study we used calcium sulphate pellets (OsteoSet T and the OsteoSet Bone-void Filler kit) as a delivery system for different antibiotics. Of a group of 32 patients with histologically and microbiologically diagnosed spondylitis, a cohort of 16 patients was treated by just a dorsal surgical approach in combination with a local antibiotic delivery system. Of these 16 patients, 14 patients showed a normalization of the infection parameters, no more bone loss in the spondylitic region, and a bony fusion after 6 to 9 months postoperatively. Two patients died from septic circumstances 4 and 6 weeks postoperatively. Two patients had to have one revision surgery because of a seroma; no other complications caused by the calcium sulphate pellets were observed. The use of calcium sulphate pellets as antibiotic delivery system allows a controlled local antibiotic therapy with an osteoconductive material in combination with a minimized surgical approach. Furthermore, calcium sulphate pellets have proven their reliable capability as bone void filler.

Effectiveness of Combination Use of Antibiotic-Loaded PerOssal® with Spinal Surgery in Patients with Spondylodiscitis

“…The complete removal of all necrotic tissue is essential, as Gram-positive staphylococci especially colonize necrotic tissues, where they produce a biofilm that drastically reduces their susceptibility to antibiotics [12,13] . Local application of antibiotic-loaded carriers has been demonstrated to be a reliable concept for prevention and treatment of chronic osteomyelitis [9] .…”

Chitosan coating to enhance the therapeutic efficacy of calcium sulfate-based antibiotic therapy in the treatment of chronic osteomyelitis

“…Slowing dissolution would also limit the osmotic effect in the localized wound environment that can lead to the formation of a seroma that requires surgical drainage. 13 …”

Antibiotic-eluting resorbable bone-void filler evaluated in a large animal infection prevention model

“…AEBVF degradation rates are likely increased by incorporating morselised CBVF, exposing internal calcium carbonate that degrades much more quickly in vivo than the HA outer covering. Webster et al reported effects of hydroxyapatite www.ecmjournal.org thickness influencing degradation rate in HAcoated implants, finding increased osteoclastic HA resorption with decreased grain size (Webster et al, 2001). Furthermore, HA-coated calcium carbonate exhibits much more rapid resorption than HA alone (McLaren et al, 2014).…”

“…Consequently, they release antibiotic for just 2-3 weeks. Furthermore, the rapid degradation of calcium-sulphate-based devices can lead to the formation of seromas, pockets of serous fluid with the potential to abscess (von Stechow et al, 2005).…”