409 Evaluation of a Novel Vancomycin-Infused, Biomimetic Bone Graft in a Rat model of Spinal Implant-Associated Infection

Abstract

INTRODUCTION: Postoperative infection is a complication of spinal fusion surgery resulting in increased patient morbidity. Strategies including intraoperative application of powdered vancomycin have been proposed to reduce the incidence of infection, however such antimicrobial effects are short-lived. METHODS: Instrumentation of the L4-L5 vertebrae was performed mimicking pedicle screw and rod fixation in 30 rats. Titanium inoculated with PBS or 1x105 CFU bioluminescent MRSA and biomimetic bone grafts infused with varying concentrations of vancomycin were inserted before closure. Infection was quantified during the six-week postoperative period using IVIS bioluminescent imaging. Arthrodesis was evaluated using micro-CT. Histological analysis was utilized to evaluate fusion and leukocyte infiltration. RESULTS: Infected animals receiving a bone graft infused with high-dose vancomycin (0.89 mg/g) exhibited significantly lower bioluminescent signal over the six-week postoperative infection period (p = 0.032) than control animals inoculated with MRSA and implanted with bone grafts lacking vancomycin. Both high and low-dose (0.18 mg/g) vancomycin-infused grafts resulted in a statistically significant reduction in average bioluminescence when compared to control animals (p = 0.018 and p = 0.027, respectively), independent of time. MicroCT analysis of animals from each group revealed pseudoarthrosis only in the control group, suggesting a correlation between infection and pseudoarthrosis. Histology revealed the formation of fusion masses in all animals receiving vancomycin infused-bone grafts regardless of MRSA inoculation, with clearance of infection indicated by lack of abscess formation. MRSA-inoculated control animals receiving no vancomycin within the bone graft demonstrated significant abscess formation and lack of fusion mass. CONCLUSIONS: The novel vancomycin-infused, biomimetic bone graft effectively mitigated implant-associated infection while promoting fusion in a rat model of instrumented lumbar fusion.