Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur Spine J. 2019 Dec;28(12):2996-3002. doi: 10.1007/s00586-019-06004-2. Epub 2019 May 13.
To assess whether a chronic bacterial infection is present in a subset of patients with pseudarthrosis after instrumented spinal fusion.
This was a prospective diagnostic study including adult patients with previous instrumented spinal fusion. Patients underwent revision surgery for either pseudarthrosis or other causes (e.g. implant removal, curve progression or junctional kyphosis) (control group). Five separate biopsies were randomly collected, intraoperatively, from the pseudarthrosis site and cultivated under both aerobic (5 days) and anaerobic (14 days) conditions. If cultivation was positive in at least 2/5 tissue samples, the biopsy was sectioned and stained using peptide nucleic acid fluorescence in situ hybridization (PNA-FISH). Confocal laser scanning microscopy was used to examine the sections and visualize bacterial aggregates.
The study included 32 pseudarthrosis and 32 control patients. Cultivation yielded bacteria in at least 1/5 biopsies in 52% of patients with no difference between the groups (p = 1.0). Bacteria of the same species was found in at least 2/5 samples in seven pseudarthrosis patients and four controls (p = 0.509). Propionibacterium acnes was found in 8 of these 11 samples. Microscopy demonstrated tissue-embedded bacterial aggregates in two of these patients but with no inflammatory cells indicating an active infection. The presence of bacteria was not associated with the number of previous spinal procedures or the pre-revision fusion length (p ≥ 0.503).
Pseudarthrosis after instrumented spinal surgery was not significantly associated with the presence of bacteria at the pseudarthrosis site. Positive cultivation results are common after spinal instrumentation, but our results indicate that they rarely represent an organized infection. These slides can be retrieved under Electronic Supplementary Material.
评估在接受器械脊柱融合术的假关节患者亚群中是否存在慢性细菌感染。
这是一项前瞻性诊断研究，纳入了先前接受过器械脊柱融合术的成年患者。患者因假关节或其他原因（如植入物取出、曲线进展或交界性后凸）而行翻修手术（对照组）。术中从假关节部位随机采集 5 份单独的活检组织，分别在有氧（5 天）和无氧（14 天）条件下进行培养。如果至少 2/5 的组织样本培养阳性，则将活检组织切片并用肽核酸荧光原位杂交（PNA-FISH）染色。使用共聚焦激光扫描显微镜检查切片并可视化细菌聚集体。
研究纳入了 32 例假关节患者和 32 例对照组患者。至少有 1/5 活检组织培养出细菌的患者在 52%，两组之间无差异（p=1.0）。至少有 2/5 样本的同一种细菌在 7 例假关节患者和 4 例对照组患者中发现（p=0.509）。在这 11 个样本中的 8 个中发现了痤疮丙酸杆菌。显微镜检查显示，在其中 2 例患者的组织中有细菌聚集体，但没有炎症细胞，表明不存在活跃感染。细菌的存在与之前脊柱手术的次数或术前融合长度无关（p≥0.503）。
器械脊柱手术后的假关节与假关节部位细菌的存在无显著相关性。脊柱器械植入后，培养阳性结果很常见，但我们的结果表明，它们很少代表有组织的感染。这些幻灯片可以在电子补充材料中检索。
