Occult infections may be the cause of chronic pain after spine surgery

CHICAGO — Chronic pain after spine surgery can affect as many as 40% of patients, even after all surgical parameters are met and are normal. Occult spinal infections may be the cause of some of these cases of pain with unknown origin, according to a speaker here.

Tucker C. Callanan, BS, said patients with these occult spinal infections may have shown no signs of preoperative infection before receiving spinal hardware.

“Occult infection is more prevalent than previously identified … future analysis will focus on a correlation between these pathogens and the implants,” he said at the Lumbar Spine Research Society Annual Meeting.

Tucker C. Callanan

Callanan and colleagues analyzed 24 consecutive patients with chronic pain undergoing revision spine surgery that included hardware removal. Prior to surgery, no antibiotics were given. At the time of hardware removal, the researchers collected periprosthetic tissue from the area around each screw hole of each implant for gram staining, histopathological analysis and long cultures to identify any changes that would indicate chronic infection.

A total of 31% of the patients were found to have occult adherent bacteria present, Callanan said. The most prevalent type of bacteria was Propionibacterium acnes, which was found in 67% of patients with positive results. The implants were also positive for Staphylococcus epidermidis, Staphylococcus simulans, Klebsiela pneumonia, and others, he said.

Callanan said the bacteria could be a contributing factor for failed back syndrome, but more research is necessary. – by Robert Linnehan

Reference:

Callanan T, et al. RF Paper #16. Presented at: Lumbar Spine Research Society Annual Meeting. April 9-10, 2015; Chicago.

Disclosure: Callanan reports no relevant financial disclosures.