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Factfinders for patient safety: Antibiotics for disc access and spinal cord stimulation trials
Ryan Mattie1, Byron J Schneider2,3, David C Miller4
1Total Spine Institute, Los Angeles, CA, USA.
Abstract:
This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding the use of antibiotics for disc access and spinal cord stimulation trials. The evidence in support of the following facts is presented: (1) There is a low but nonzero risk of discitis due to percutaneous intervertebral disc access. Strategies to mitigate this risk include use of strict aseptic technique, use of a needle stylet, and prophylactic intravenous or intra-discal antibiotics. (2) In low-risk patients, it may not be necessary to continue antibiotics throughout the percutaneous or staged trial period; however, in high-risk patients, or in trials lasting more than five days, antibiotics should be considered on a case-by-case basis.
Insights
Antibiotics can reduce the risk of discitis during spinal procedures. Prophylactic antibiotics are recommended for disc access, with continued use considered for high-risk spinal cord stimulation trials.
Area of Science:
- Infectious Disease
- Neurosurgery
- Pain Management
Background:
- Percutaneous intervertebral disc access carries a low risk of discitis.
- Spinal cord stimulation (SCS) trials involve percutaneous procedures.
- Evidence-based recommendations are needed for antibiotic use in these procedures.
Purpose of the Study:
- To summarize evidence on antibiotic use for disc access.
- To outline recommendations for antibiotic prophylaxis during SCS trials.
Main Methods:
- Review of existing evidence on discitis risk and prevention.
- Analysis of factors influencing antibiotic necessity during SCS trials.
Main Results:
- Strict aseptic technique, needle stylets, and prophylactic antibiotics mitigate discitis risk.
- Continuous antibiotics may not be necessary for low-risk SCS trial patients.
- Antibiotic use should be individualized for high-risk patients or prolonged SCS trials.
Conclusions:
- Prophylactic antibiotics are a key strategy to prevent discitis after percutaneous disc access.
- Antibiotic duration for SCS trials should be tailored to patient risk and trial length.
