Authors: Rauschmann Michael Andre, MD; von Stechow, Dietrich, MD; Braune, Carsten, MD; Scale Detlev, MD
Title: Therapeutic use of antibiotic-loaded calcium-sulphate pellets in spinal surgery
Addresses: Dept. of Orthopaedic Surgery, University Hospital Frankfurt/Main, Marienburgstr.2, 60528 Frankfurt/Main, Germany
Purpose: The increasing number of non-specific infections due to multi-resistant bacteria and tuberculosis require new or modified therapeutic pathways in spinal surgery. In spinal infection cases, minimization of the surgical approach by using local antibiotic treatment and no ventral approach reduces the anesthesiological and surgical risks in multimorbid patients. As a local antibiotic delivery system in infection cases, calcium sulphate pellets have proven to be a reliable medical device in addition to their capability as bone void filler. The goal of the study was to prove that calcium sulphate pellets as a antibiotic delivery system, are an alternative treatment regime in spondylitis in multimorbid patients.
Methods: A total of 32 patients were treated by different approaches with and without additional interposition of bonegrafts in combination with a local antibiotic delivery system. This specific study focuses on one cohart of sixteen patients with histologically and microbiologically diagnosed spondylitis, which was treated by a single dorsal approach either transpedicular, transspinal in the lumbar spine or via a costotransverse approach in the thoracic spine. The procedure included a thorough debridement, a refilling with the local antibiotic delivery system and dorsal instrumentation.
Results: 16 patients showed a normalization of the infection parameters, no more bone loss in the spondylitic region and a bony fusion after 6-9 month postoperatively. Two patients died due to septic circumstances in between 4-6 weeks postoperatively. Two patients had to undergo a revision surgery.
Discussion: Calcium-sulphate pellets (OSTEOSET Tâ and the BVF-kitâ) were used as a delivery system for different antibiotics and offering the option of adding an osteoconductive substance. For all bacterial induced spondylitic infections, this treatment approach can be a helpful and an alternative method in multimorbid patients who require an ventral approach for the complete surgical debridement of the necrotic and granulated tissue. The minor invasive technique reduces the operating time and the anesthesiological risk of the retroperitoneal or thoracic approach. Further investigations are ongoing to determine, if a loss of correction occurs during the following years in comparison with a dorso-ventral approach.
Significance: The use of calcium sulphate pellets as antibiotic delivery system allows a controlled local antibiotic therapy with a osteoconductive material in combination with minimized surgical approach.