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[Low-grade-infections after spondylodeses-A chameleon? : Current findings and therapeutic strategies]
M Akbar1, B Lehner2, Y-M Ryang3
1Clinic für Wirbelsäulenerkrankungen und -Therapien, MEOCLINIC, Berlin, Deutschland.
Background:
Low-grade infections are caused by low-virulence pathogens. The course of these infections is often mild, which is why they are often delayed or not recognized at all. Chronic infections can lead to osteolysis and implant loosening. The rate of complications requiring revision, such as implant loosening or material failure, is known from the literature. However, the rate of low-grade infections in patients requiring spinal revision surgery remains unclear.
Purpose:
The aim of this review is to present the latest treatment strategies for low-grade infections. The diagnostic and therapeutic options are summarized in the form of algorithms. The aim of this work is to raise an awareness of the possibility of a low-grade infection in patients undergoing spinal revision surgery.
Materials And Methods:
Review of the literature RESULTS: The detection of low-grade infections is difficult from both a clinical and a radiological point of view. In the event of unexplained implant loosening or failure despite the lack of local inflammatory signs and often normal laboratory parameters, a low-grade infection must be considered. Multiple microbiological sampling must be requested as part of the revision surgery. A histological examination is recommended for all revision surgery, especially if a low-grade infection is suspected. The diagnosis should ideally be completed by sonicating the implants with subsequent microbiological incubation of the preserved samples. If a low-grade infection is suspected, the biofilm-covered implant should be removed or replaced if instability/no fusion is present. The use of topical antibiotics could be useful, but its effectiveness in treating low-grade infections has not yet been sufficiently demonstrated.
Discussion:
An algorithm for clinical decision-making in terms of diagnostic and therapeutic options is suggested.
Insights
Low-grade infections, often mild and hard to detect, can cause implant loosening in spinal revision surgery. Early recognition and specific diagnostic methods are crucial for effective treatment strategies.
Area of Science:
- Spinal surgery
- Infectious diseases
- Orthopedics
Background:
- Low-grade infections, caused by low-virulence pathogens, present mild symptoms and are frequently overlooked.
- Chronic low-grade infections can lead to significant complications like osteolysis and implant loosening.
- The incidence of low-grade infections in patients undergoing spinal revision surgery is not well-established.
Purpose of the Study:
- To present current treatment strategies for low-grade infections.
- To provide diagnostic and therapeutic algorithms for managing these infections.
- To increase awareness of low-grade infections in spinal revision surgery patients.
Main Methods:
- Comprehensive literature review.
- Analysis of diagnostic challenges (clinical, radiological, laboratory).
- Evaluation of microbiological and histological sampling techniques, including implant sonication.
Main Results:
- Low-grade infections are challenging to diagnose due to subtle clinical and radiological signs, often with normal lab parameters.
- Suspected low-grade infections necessitate multiple microbiological samples and histological examination during revision surgery.
- Implant removal/replacement and potential use of topical antibiotics are considered for biofilm-covered implants, though efficacy requires further study.
Conclusions:
- An algorithm for clinical decision-making in diagnosing and treating low-grade infections is proposed.
- Highlighting the importance of considering low-grade infection in unexplained spinal implant complications.
- Emphasizing the need for advanced diagnostic techniques for accurate identification.
