• Lukas Leitner, Isabella Malaj, Patrick Sadoghi, Florian Amerstorfer, Mathias Glehr, Klaus Vander, Andreas Leithner, and Roman Radl.
• Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
• Eur Spine J. 2018 Oct 1; 27 (10): 2529-2535.

PurposeSpinal fusion is used for treatment of spinal deformities, degeneration, infection, malignancy, and trauma. Reduction of motion enables osseous fusion and permanent stabilization of segments, compromised by loosening of the pedicle screws (PS). Deep implant infection, biomechanical, and chemical mechanisms are suspected reasons for loosening of PS. Study objective was to investigate the frequency and impact of deep implant infection on PS loosening.MethodsIntraoperative infection screening from wound and explanted material sonication was performed during revision surgeries following dorsal stabilization. Case history events and factors, which might promote implant infections, were included in this retrospective survey.Results110 cases of spinal metal explantation were included. In 29.1% of revision cases, infection screening identified a germ, most commonly Staphylococcus (53.1%) and Propionibacterium (40.6%) genus. Patients screened positive had a significant higher number of previous spinal operations and radiologic loosening of screws. Patients revised for adjacent segment failure had a significantly lower rate of positive infection screening than patients revised for directly implant associated reasons. Removal of implants that revealed positive screening effected significant pain relief.ConclusionsChronic implant infection seems to play a role in PS loosening and ongoing pain, causing revision surgery after spinal fusion. Screw loosening and multiple prior spinal operations should be suspicious for implant infection after spinal fusion when it comes to revision surgery. These slides can be retrieved under Electronic Supplementary Material.

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