PMID- 36282416
OWN - NLM
STAT- MEDLINE
DCOM- 20230301
LR  - 20230329
IS  - 2212-1358 (Electronic)
IS  - 2212-134X (Print)
IS  - 2212-134X (Linking)
VI  - 11
IP  - 2
DP  - 2023 Mar
TI  - A high prevalence of Cutibacterium acnes infections in scoliosis revision 
      surgery, a diagnostic and therapeutic dilemma.
PG  - 319-327
LID - 10.1007/s43390-022-00599-1 [doi]
AB  - PURPOSE: To investigate if serum inflammatory markers or nuclear imaging can 
      accurately diagnose a chronic spinal instrumentation infection (SII) prior to 
      surgery. METHODS: All patients who underwent revision of spinal instrumentation 
      after a scoliosis correction between 2017 and 2019, were retrospectively 
      evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and 
      Erythrocyte Sedimentation Rate (ESR), (18)F-fluorodeoxyglucose positron emission 
      tomography combined with computed tomography (FDG-PET/CT) and 
      Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy 
      (TPBS) to diagnose infection were studied. Patients with an acute infection or 
      inadequate culture sampling were excluded. SII was diagnosed if >/= 2 of the same 
      microorganism(s) were isolated from intra-operative tissue cultures. RESULTS: 30 
      patients were included. The indication for revision surgery was pseudoarthrosis 
      in the majority of patients (n = 15). 22 patients (73%) were diagnosed with SII. 
      In all infected cases, Cutibacterium acnes was isolated, including 5 cases with a 
      polymicrobial infection. The majority of patients had low inflammatory parameters 
      preoperatively. For CRP > 10.0 mg/L, the sensitivity was 9.1% and specificity 
      100%; for ESR > 30 mm/h, the sensitivity was 9.1% and specificity 100%. The 
      diagnostic accuracy for nuclear imaging was 64% for the FDG-PET/CT and 67% for 
      the TPBS to diagnose infection. CONCLUSIONS: The prevalence of SII in patients 
      undergoing revision spinal surgery is high, with Cutibacterium acnes as the main 
      pathogen. No diagnostic tests could be identified that could accurately diagnose 
      or exclude SII prior to surgery. Future studies should aim to find more sensitive 
      diagnostic modalities to detect low-grade inflammation.
CI  - (c) 2022. The Author(s).
FAU - Gelderman, Stefan J
AU  - Gelderman SJ
AUID- ORCID: 0000-0003-3885-8179
AD  - Department of Orthopaedic Surgery, University of Groningen, University Medical 
      Center Groningen, Groningen, The Netherlands. stefangelderman@outlook.com.
FAU - Faber, Christhoper
AU  - Faber C
AD  - Department of Orthopaedic Surgery, University of Groningen, University Medical 
      Center Groningen, Groningen, The Netherlands.
FAU - Kampinga, Greetje A
AU  - Kampinga GA
AD  - Department of Medical Microbiology and Infection Prevention, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Jutte, Paul C
AU  - Jutte PC
AD  - Department of Orthopaedic Surgery, University of Groningen, University Medical 
      Center Groningen, Groningen, The Netherlands.
FAU - Ploegmakers, Joris J W
AU  - Ploegmakers JJW
AD  - Department of Orthopaedic Surgery, University of Groningen, University Medical 
      Center Groningen, Groningen, The Netherlands.
FAU - Glaudemans, Andor W J M
AU  - Glaudemans AWJM
AD  - Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, 
      University of Groningen, University Medical Center Groningen, Groningen, The 
      Netherlands.
FAU - Wouthuyzen-Bakker, Marjan
AU  - Wouthuyzen-Bakker M
AD  - Department of Medical Microbiology and Infection Prevention, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20221025
PL  - England
TA  - Spine Deform
JT  - Spine deformity
JID - 101603979
RN  - 0Z5B2CJX4D (Fluorodeoxyglucose F18)
RN  - 0 (Biomarkers)
SB  - IM
MH  - Humans
MH  - *Fluorodeoxyglucose F18
MH  - Positron Emission Tomography Computed Tomography
MH  - Reoperation
MH  - Retrospective Studies
MH  - *Scoliosis/diagnostic imaging/epidemiology/surgery
MH  - Prevalence
MH  - Biomarkers
PMC - PMC9970938
OTO - NOTNLM
OT  - Diagnostics
OT  - Revision surgery
OT  - Spinal instrumentation infection
OT  - Treatment
COIS- None of the authors had funding that might pose a conflict of interest in 
      connection with the submitted article.
EDAT- 2022/10/26 06:00
MHDA- 2023/03/03 06:00
PMCR- 2022/10/25
CRDT- 2022/10/25 11:19
PHST- 2021/09/30 00:00 [received]
PHST- 2022/10/01 00:00 [accepted]
PHST- 2022/10/26 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2022/10/25 11:19 [entrez]
PHST- 2022/10/25 00:00 [pmc-release]
AID - 10.1007/s43390-022-00599-1 [pii]
AID - 599 [pii]
AID - 10.1007/s43390-022-00599-1 [doi]
PST - ppublish
SO  - Spine Deform. 2023 Mar;11(2):319-327. doi: 10.1007/s43390-022-00599-1. Epub 2022 
      Oct 25.