Jägersberg Max, Feihl Susanne, Ringel Florian
Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
Department of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
J Spine Surg. 2020 Dec;6(4):814-819. doi: 10.21037/jss-20-585.
This article outlines some promising future concepts against postoperative spinal implant infections on the basis of today available literature. The ever-adapting bacteria causing this common complication compel a corresponding continuous research about best effective treatment. The aim is to give a perspective on several future attack-points: surgical infection prevention strategies such as technical optimization of implants and surgical technique; faster diagnostic tools to detect infection, especially in the context of late infections with low-virulent germs and with regard to decision-making in the course of the surgical workflow; and combined surgical and medical treatment options against implant infections. The surgical treatment section will also state open issues concerning implant removal, and the medical treatment section will give an outlook to promising medical alternatives in a post-antibiotic era. To keep up in this field will be important to retain spine surgery in the future as the state-of-the-art treatment option for mandatory spinal interventions in the presence of tumor or trauma and even more so as an attractive option for patients with degenerative spinal disorder for improvement of their life quality.
本文基于当前可得文献，概述了一些针对术后脊柱植入物感染的、颇具前景的未来概念。引发这种常见并发症的细菌不断演变，这促使人们持续开展关于最有效治疗方法的相应研究。目的是展望几个未来的攻击点：手术感染预防策略，如植入物和手术技术的技术优化；用于检测感染的更快诊断工具，特别是在低毒力病菌引起的晚期感染情况下以及在手术工作流程中的决策方面；以及针对植入物感染的联合手术和药物治疗方案。手术治疗部分还将阐述与植入物取出相关的未解决问题，药物治疗部分将展望抗生素后时代有前景的药物替代方案。在这一领域紧跟前沿对于未来将脊柱手术保留为肿瘤或创伤情况下强制性脊柱干预的最先进治疗选择至关重要，对于患有退行性脊柱疾病的患者而言，更是改善其生活质量的有吸引力的选择。
