PT  - JOURNAL ARTICLE
AU  - Mengis-Palleck, Charles Louis
AU  - Tomé-Bermejo, Félix
AU  - Piñera-Parrilla, Ángel
AU  - Cervera-Irimia, Javier
AU  - Gallego-Bustos, Jesús
AU  - Garzón-Márquez, Francisco
AU  - Rodríguez-Arguisjuela, María G.
AU  - Sanz-Aguilera, Sylvia
AU  - Peiro-Garcia, Alejandro
AU  - Álvarez-Galovich, Luis
TI  - Surgical Site Infection After Polymethyl Methacrylate Pedicle Screw Augmentation in Osteoporotic Spinal Vertebrae: A Series of 537 Cases
AID  - 10.14444/8474
DP  - 2023 May 17
TA  - International Journal of Spine Surgery
PG  - 8474
4099  - https://www.ijssurgery.com/content/early/2023/05/17/8474.short
4100  - https://www.ijssurgery.com/content/early/2023/05/17/8474.full
AB  - Background Retrospective observational study of prospectively collected outcomes.Objective The use of transpedicular screws augmented with polymethyl methacrylate (PMMA) is an alternative for patients with osteoporotic vertebrae. To investigate whether using PMMA-augmented screws in patients undergoing elective instrumented spinal fusion (ISF) is correlated with an increased risk of infection and the long-term survival of these spinal implants after surgical site infection (SSI).Methods We studied 537 consecutive patients who underwent ISF at some point within a 9-year period, involving a total of 2930 PMMA-augmented screws. Patients were classified into groups: (1) those whose infection was cured with irrigation, surgical debridement, and antibiotic treatment; (2) those whose infection was cured by hardware removal or replacement; and (3) those in whom treatment failed.Results Twenty eight of the 537 patients (5.2%) developed SSI after ISF. An SSI developed after primary surgery in 19 patients (4.6%) and after revision surgery in 9 (7.25%). Eleven patients (39.3%) were infected with gram-positive bacteria, 7 (25%) with gram-negative bacteria, and 10 (35.7%) with multiple pathogens. By 2 years after surgery, infection had been cured in 23 patients (82.15%). Although there were no statistically significant differences in infection incidence between preoperative diagnoses (P = 0.178), the need to remove hardware for infection control was almost 80% lower in patients with degenerative disease. All screws were safely explanted while vertebral integrity was maintained. PMMA was not removed, and no recementing was done for new screws.Conclusions The success rate for treatment of deep infection after cemented spinal arthrodesis is high. Infection rate findings and the most commonly found pathogens do not differ between cemented and noncemented fusion. It does not appear that the use of PMMA in cementing vertebrae plays a pivotal role in the development of SSIs.Level of Evidence 4.