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

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 McDowell, 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

December 2018, pp 1 - 9
DOI
10.1007/s00586-018-5838-z
First Online: 01 December 2018
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 

Conclusion

Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]