Use of Antibiotic-Eluting Calcium Sulfate in the Management of Post-surgical Spinal Infections and Spondylodiscitis:...

Postoperative spinal infections, including spondylodiscitis and surgical site infections (SSI) following instrumentation, remain significant complications associated with considerable morbidity and complex management. Standard treatment often involves extensive surgical debridement, implant removal or revision, and prolonged systemic antibiotic therapy; however, achieving adequate local antibiotic concentrations can be challenging. In this retrospective case series, we evaluate the use of bioabsorbable calcium sulfate as a local antibiotic delivery system in eight adult patients (≥18 years; four women; mean age: 58.6 years) managed for post-instrumentation spinal infections between 2021 and 2025. Patient inclusion required a confirmed deep surgical site infection or spondylodiscitis with implant involvement, while patients with severe renal impairment or superficial infections were excluded. Surgical management included thorough debridement combined with implant removal or revision and, where indicated, reconstructive procedures such as corpectomy and interbody fusion. Antibiotic-loaded calcium sulfate (Stimulan, Biocomposites Ltd., Staffordshire, United Kingdom) beads were used for local antibiotic delivery based on intraoperative assessment and microbiological considerations. All patients tolerated the procedure well, with no immediate complications attributable to the calcium sulfate implantation. Favorable clinical outcomes were observed in all cases, with the resolution of symptoms, normalization of inflammatory markers, and radiological evidence of infection control during follow-up. The mean duration of hospital stay was 6.0 days. These findings suggest that antibiotic-eluting calcium sulfate is a safe and effective adjunct in the management of postoperative spinal infections, facilitating targeted local antibiotic delivery and contributing to successful infection control.