Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections.

Manu N Capoor, Jan Lochman, Andrew Mc Dowell, Jonathan E Schmitz, Martin Solansky, Martina Zapletalova, Todd F Alamin, Michael F Coscia, Steven R Garfin, Radim Jancalek, Filip Ruzicka, A Nick Shamie, Martin Smrcka, Jeffrey C Wang, Christof Birkenmaier, Ondrej Slaby

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2 Citations (Scopus)

Abstract

PURPOSE: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. METHODS: Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. RESULTS: Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). CONCLUSION: Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.
Original languageEnglish
Pages (from-to)783-791
Number of pages8
JournalEuropean Spine Journal
Volume4
Publication statusE-pub ahead of print - 1 Dec 2018

Keywords

  • Biofilm; Cefazolin; Clindamycin; Cutibacterium acnes; Degenerative disc disease; Propionibacterium acnes; Surgical prophylaxis; Vancomycin

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    Capoor, M. N., Lochman, J., Mc Dowell, A., Schmitz, J. E., Solansky, M., Zapletalova, M., Alamin, T. F., Coscia, M. F., Garfin, S. R., Jancalek, R., Ruzicka, F., Shamie, A. N., Smrcka, M., Wang, J. C., Birkenmaier, C., & Slaby, O. (2018). Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections. European Spine Journal, 4, 783-791.