Debridement and fusion with PEEK-implants in

Letter to the Editor

Debridement and fusion with PEEK-implants in purulent sponylodiscitis: a clinical experience with 9 patients

Agnes Brase, Florian Ringel, Carsten Stüer, Bernhard Meyer, Michael Stoffel Dear Editor, Spinal infections occur with increasing incidence. In case of neurological deficits and/or segmental instability surgical treatment including decompression and stabilisation is required. As yet there is plenty experience with autologous bone or titanium implants, but only scarce experience with using polyetheretherketone (PEEK)implants in operative treatment of spinal infections. Both Mondorf et al. and Walter et al. described their clinical experience with single-step surgery using PEEKimplants for the cervical spine in 5 patients suffering from spondylodiscitis with good outcome and complete recovery from the infection in all cases

1, 3

. Pee at al. described the use of PEEK-implants in the operative

treatment of 10 patients presenting with lumbar spondylodiscitis with comparable satisfactory findings 2. We present a consecutive retrospective series of 9 patients (3 cervical (monosegmental) und 6 lumbar (3 mono-, 3 bisegmental spondylodiscitis) treated in our institution between January 2006 and May 2010 consisting of clinical evaluation, standardised questionnaires (EQ-5D, SF-36 and ODI), MRI and C-reactive protein levels collected during the perioperative period and the outpatient follow ups (mean 13 months). This series represents currently our complete experience with PEEK in this disease. The mean age was 65 years (min-max 47-82). All patients had significant neck pain, one patient complained of brachialgia. 2 cervical and 2 lumbar spondylodiscitis patients suffered from infection with significant epidural mass and sensorimotor deficits, in one case even with tetraplegia and bowel-/bladder dysfunction. 2 patients presented a septic disease with significantly increased infection parameters, especially the CRP. 4 patients had additional further skeletal infections. The most common pathogenic germ was staphylococcus aureus, less common were Pseudomonas aeruginosa or Neisseria species. The cervical single-step surgical procedure consisted of an anterior approach and debridement followed by the implantation of a PEEK-cage (Nubic or Athlet, Signus Alzenau) for intervertebral disc or vertebral body replacement. In lumbar spondylodiscitis a dorsal decompression and debridement followed by posterior stabilisation and intervertebral fusion using PEEK-implants via the TLIF-technique (Mobis, Signus Alzenau) was performed. The antibiotic therapy started immediately after surgery and material asservation for microbiological tests, often included clindamycine and lasted on average 10,2 days intravenously till microbiological identification of the pathogenic germ, decrease of CRP and relief of complaints, and was thereafter continued per os on average for 3,9 months. All patients recovered from the infection without relapse. The neurological deficits improved in all patients. Pain significantly declined [mean ∆VAS -4,8: before surgery 8,1; follow up 3,2]. Mean ODI decreased from 77 prior to surgery to 31 after surgery and life quality (estimated with EQ-5D) improved likewise. On the basis of our own experience, we assume that PEEK-implants seem to be an excellent choice for singlestep operative treatment of cervical and lumbar spondylodiscitis being primary stable, good biocompatible and

associated with a high recovery and fusion rate. Thus, we can confirm the experience published in the literature.

spondylodiscitis L4/5

before operation

6 months after surgery

spondylodiscitis C7/Th1

before operation

9 months after surgery

1. Mondorf Y, Gaab MR, Oertel JMK PEEK cage cervical ventral fusion in spondylodiscitis Acta Neurochirurgica 151:1537–1541, 2009 2. Pee YH, Park JD, Choi Y-G and Lee S-H Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage Journal of Neurosurgery Spine 8:405–412, 2008 3. Walter J, Kuhn SA, Reichart R, Kalff R, Ewald Ch PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series European Spine Journal 2010 Jan 13