Interim Use of Antibiotic-loaded Cement Spacer for Patients with Infected Cervical Fusion.

OBJECTIVE: The management of postoperative deep infection after anterior cervical discectomy and fusion (ACDF) remains challenging for spine surgeons. Our institution uses handmade antibiotic-loaded cement spacers to treat these complex cases. This study aimed to determine the efficacy and feasibility of this treatment.

METHODS: This study included four patients with deep cervical spine infections after ACDF who underwent our treatment between March 2012 and January 2022. Patients' laboratory data, visual analog scale (VAS) scores, comorbidities, complications, and neurological status were recorded. Their clinical conditions were also evaluated based on the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and Odom's criteria.

RESULTS: Infection eradication was achieved in all patients after treatment. The average preoperative VAS score was 7.5 (range: 7-8); this decreased to 1.25 (range: 1-2) at 1 year postoperatively. None of the patients experienced severe complications, such as neurological deterioration or bone graft dislodgement. The NDI improved from a preoperative value of 54% (range: 70-84%) to 6% (range: 4-8%) at 1 year postoperatively. The JOA score improved from a preoperative score of 10.25 (range: 10-11) to 14.75 (range: 14-16) at 1 year postoperatively. All patients achieved excellent outcomes based on Odom's criteria at 1 year postoperatively.

CONCLUSION: Good clinical outcomes were achieved in this study. Although two-stage surgery is required, this technique could be an alternative for patients with postoperative deep infection after ACDF.