Treatment of lumbar discitis using silicon nitride spinal spacers: A case series and literature review

Area of Science:

• Spinal surgery
• Infectious diseases
• Biomaterials science

Background:

• Lumbar pyogenic discitis is a rare but serious spinal infection, often challenging to diagnose and treat due to varied symptoms and high prevalence of low-back pain.
• Increasing incidence linked to patient susceptibility and advanced diagnostics.
• Treatment options range from conservative antibiotic therapy to aggressive surgical interventions like discectomy and spinal fusion.

Purpose of the Study:

• To present two case studies of lumbar pyogenic discitis treated with a novel antimicrobial silicon nitride (Si3N4) spacer.
• To evaluate the efficacy of Si3N4 spacers in promoting spinal fusion and resolving infection without instrumentation.

Main Methods:

• Two patients with lumbar pyogenic discitis (Escherichia coli and Candida albicans) underwent single-level anterior discectomy.
• Spinal fusion was performed using an antimicrobial silicon nitride (Si3N4) spacer for stabilization, without additional instrumentation.
• One patient received localized antibiotics; both were monitored with follow-up CT and MRI scans.

Main Results:

• Successful resolution of discitis in both cases following treatment with Si3N4 spacers.
• No recurrence of symptoms or infection was observed during follow-up.
• CT and MRI scans confirmed infection resolution and successful fusion.

Conclusions:

• Silicon nitride (Si3N4) demonstrated potential as an antimicrobial spinal spacer, promoting rapid arthrodesis and resisting bacterial adhesion.
• Its compatibility with imaging modalities and ability to facilitate fusion without instrumentation make it attractive for treating pyogenic discitis.
• The use of Si3N4 antimicrobial spacers may improve outcomes for patients with lumbar pyogenic discitis.