• Ehab Shiban, Ann-Kathrin Joerger, Insa Janssen, Mohammed Issa, Nicole Lange, Arthur Wagner, Susanne Feihl, Florian Ringel, and Bernhard Meyer.
• Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany.
• Neurosurgery. 2020 Oct 15; 87 (5): 964-970.

BackgroundSpinal instrumentation can be associated with complications, including implant loosening. Hitherto, implant loosening has mainly been attributed to mechanical overload.ObjectiveTo examine the role of low-grade infections as the cause of implant failure in suspected aseptic implant loosening following spinal instrumentation.MethodsA prospective single center observational study was performed. All patients who had revision surgery following spinal instrumentation between August 2015 and February 2018 were screened. Patients with revision surgery due to screw loosening on the computed tomograhy scan constituted the study group. Patients in which the screws where not loosened but removal was performed for other reasons formed the comparison group. Intraoperative swabs were taken and sonication was performed with the explanted material. Results of microbiological cultivation were analyzed.ResultsA total of 59 patients were included in the study group and 34 in the comparison group. In the study group in 42.4% of the cultures a bacterium was detected, while in the comparison group only in 17.6%. 84%, and 83.3% of these germs were detected by sonication in the study and comparison group, respectively. The rate of positive cultures was significantly higher in the study group compared to the comparison group (P = .001). The most frequent bacterium cultivated in both groups was Propionibacterium acnes, followed by Staphylococcus species.ConclusionFor patients with screw loosening a high level of suspicion for a low-grade infection should be raised. Cultures should be performed from the sonication fluid of the explanted devices in all patients with symptomatic screw loosening.Copyright © 2020 by the Congress of Neurological Surgeons.

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