• Daniel García-Pérez, Alfonso Lagares, Ana María Castaño-León, Irene Panero, Pablo M Munarriz, Juan Delgado-Fernández, Luis Jiménez-Roldán, Angel Pérez-Núñez, Jose Antonio F Alén, and Igor Paredes.
• Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain.
• Spine. 2021 Nov 1; 46 (21): 1485-1494.

Study DesignA prospective single center observational study.ObjectivesThe aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to describe risk factors and radiological findings associated with spinal implant infection.Summary Of Background DataAlthough PS loosening has mainly been attributed to mechanical overload, implant colonization and biofilm formation have recently been suggested. Culturing of sonication fluid implants is promising in the field of spine instrumentation infection, but little data are available.MethodsWe prospectively included all patients who were subjected to implant removal. PS loosening was assessed with computed tomography (CT) scan. Different clinical and radiological parameters which could serve as indicators of implant infection were studied.ResultsThirty-eight patients were included in the study and 11 of them (29%) had a positive sonication result. Patients with spinal implant infection were associated with screw loosening (P = 0.005). Particularly, those screws with a positive microbiological culture showed signs of screw loosening in the preoperative CT scan (P < 0.001). Our results also showed that radiological screw loosening at L1-L3 level, and loosened larger constructs were associated with screw microbial colonization. The most common isolated microorganisms were coagulase-negative staphylococci and Cutibacterium acnes. An implant-based multivariate analysis indicated that screw loosening, the absence of prophylactic cefazolin, ICU hospitalization, screw breakage, and L1-L3 spine level were independent risk factors for implant-associated infection. Our model exhibited a high predictive power with an area under the curve of 0.937.ConclusionAs clinical presentation of deep implant chronic infection is unspecific, consideration of these factors enables preoperative prediction and risk stratification of implant colonization, thus helping patient's management.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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