Abstract
Implant related infection following spine surgery is a devastating complication for patients and can potentially lead to significant neurological compromise, disability, morbidity, and even mortality. This paper provides an overview of the existing animal models of postoperative spine infection and highlights the strengths and weaknesses of each model. In addition, there is discussion regarding potential modifications to these animal models to better evaluate preventative and treatment strategies for this challenging complication. Current models are effective in simulating surgical procedures but fail to evaluate infection longitudinally using multiple techniques. Potential future modifications to these models include using advanced imaging technologies to evaluate infection, use of bioluminescent bacterial species, and testing of novel treatment strategies against multiple bacterial strains. There is potential to establish a postoperative spine infection model using smaller animals, such as mice, as these would be a more cost-effective screening tool for potential therapeutic interventions.
Highlights
Postoperative infection is a devastating complication following implant related spine surgery and can lead to neurological compromise, disability, and even increased morbidity and/or mortality
In this study, based on surgical site aerobic swabs and tissue cultures obtained on postoperative day (POD) 5, all the animals who did not receive any prophylactic antibiotics developed infection and all the animals who received preoperative or postoperative cefazolin had negative S. aureus cultures, regardless of whether or not hardware was implanted
Only the 1 × 106 colony-forming units (CFU) S. aureus group had histopathologic evaluation of acute osteomyelitis, as evidenced by osteonecrosis and neutrophil leukocyte infiltration. These authors conclude that the optimal inoculum of S. aureus in a rat model of spine infection is 1 × 106 CFU
Summary
Postoperative infection is a devastating complication following implant related spine surgery and can lead to neurological compromise, disability, and even increased morbidity and/or mortality. In this study, based on surgical site aerobic swabs and tissue cultures obtained on POD 5, all the animals who did not receive any prophylactic antibiotics developed infection and all the animals who received preoperative or postoperative cefazolin had negative S. aureus cultures, regardless of whether or not hardware was implanted. Only the 1 × 106 CFU S. aureus group had histopathologic evaluation of acute osteomyelitis, as evidenced by osteonecrosis and neutrophil leukocyte infiltration Given these findings, these authors conclude that the optimal inoculum of S. aureus in a rat model of spine infection is 1 × 106 CFU. A 2.5 cm dorsal skin incision was made longitudinally in the midline, followed by a single incision in the fascia to expose the spinous process which was excised using a small rongeur to mimic a partial laminectomy (Figures 2A,B). Rabbits received either preoperative cefazolin (30 mg/kg administered 15 min prior to incision) or preoperative cefazolin
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