Efficacy and safety with the use of Antibiotic-impregnated Poly-methyl methacrylate (AI-PMMA) for thoracolumbar spinal reconstruction in pyogenic Spondylodiscitis: Retrospective cohort study

Abstract

BackgroundSurgical treatment of spinal osteomyelitis and discitis remains challenging due to the risk of implant colonization. We sought to demonstrate the safety and efficacy of using antibiotic-impregnated poly-methyl methacrylate (AI-PMMA) in spinal reconstruction for pyogenic spondylodiscitis. MethodWe retrospectively analyzed prospective data on consecutive patients who underwent AI-PMMA interbody fusion for thoracolumbar pyogenic spondylodiscitis from December 2011 to October 2016 at a single institution with multiple surgeons. We included consecutive patients who underwent AI-PMMA spinal reconstruction and fusion and were older than 18 years of age. All patients were included in the analysis regardless of their follow-up status who had previous spine surgery in the same area were excluded. Vancomycin powder was mixed with PMMA and tobramycin. The AIPMMA was introduced into the disc space as 5–10 mm beads, then contoured to fit. The primary outcome was fusion using CT or X-ray. Secondary outcomes were recurrent infection, PMMA-related complications, and VAS results. Descriptive statistics and univariate analyses were used. ResultsSixty-two patients were included in the study. The mean follow-up interval was 18.6 months (3–66 months). Sixty-six AI-PMMA levels demonstrated a fusion rate of 100% (95% CI: 94.9%–100%). There was no cement extravasation or embolism. One patient (1.6%) developed a recurrent infection at the same level requiring revision surgery. Five patients (8%) died on long-term follow-up due to non-PMMA/infection-related causes. VAS back showed significant improvement in pain (7.8 vs. 3.5; 95% CI 2.8–5.8; p = 0.00). ConclusionWe demonstrated that the application of AI-PMMA for spinal reconstruction in pyogenic spondylodiscitis is safe and efficacious. The study is limited by its retrospective design. Prospective studies are warranted.