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Presentation and management of infection in total disc replacement: A review
Journal article   Open access   Peer reviewed

Presentation and management of infection in total disc replacement: A review

Hannah Spece, Armen Khachatryan, Frank M. Phillips, Todd H. Lanman, Gunnar B.J. Andersson, Grant E. Garrigues, Hyun Bae, Joshua J. Jacobs and Steven M. Kurtz
North American Spine Society journal (NASSJ), v 18, 100320
01 Jun 2024
DOI: https://doi.org/10.1016/j.xnsj.2024.100320
PMID: 38590972
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.xnsj.2024.100320View
Published, Version of Record (VoR) Open

Abstract

Cervical spine Imaging Infection Lumbar spine Total disc replacement (TDR) Bacteria
Total disc replacement (TDR) is widely used in the treatment of cervical and lumbar spine pathologies. Although TDR infection, particularly delayed infection, is uncommon, the results can be devastating, and consensus on clinical management remains elusive. In this review of the literature, we asked: (1) What are the reported rates of TDR infection; (2) What are the clinical characteristics of TDR infection; and (3) How has infection been managed for TDR patients? We performed a search of the literature using PubMed and Embase to identify studies that reported TDR infection rates, the identification and management of TDR infection, or TDR failures with positive cultures. Twenty database studies (17 focusing on the cervical spine and 3 on the lumbar spine) and 10 case reports representing 15 patients were reviewed along with device Summary of Safety and Effectiveness Data reports. We found a lack of clarity regarding how infection was diagnosed, indicating a variation in clinical approach and highlighting the need for a standard definition of TDR infection. Furthermore, while reported infection rates were low, the absence of a clear definition prevented robust data analysis and may contribute to underreporting in the literature. We found that treatment strategy and success rely on several factors including patient symptoms and time to onset, microorganism type, and implant positioning/stability. Although treatment strategies varied throughout the extant literature, common practices in eliminating infection and reconstructing the spine emerged. The results will inform future work on the creation of a more robust definition of TDR infection and as well as recommendations for management.

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Orthopedics
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