Surgical Treatment of Lumbosacral Discospondylitis with Gentamicin-Impregnated Polymethylmethacrylate Cement and Omentalization

Abstract

Objective The aim of this study was to describe a novel technique using a gentamicin-impregnated polymethylmethacrylate (PMMA) plug for the surgical treatment of lumbosacral discospondylitis with concomitant instability.

Clinical Report A 7-year-old male German Shepherd dog with lumbosacral (LS) discospondylitis and previously diagnosed with degenerative lumbosacral disease underwent ventral slot and distraction of the L7 to S1 intervertebral space with a gentamicin-impregnated PMMA plug. The lumbosacral joint was accessed via the abdomen. Samples were collected for bacterial culture and sensitivity, fungal culture and histopathological examination. The surgical site was omentalized. Long-term oral antimicrobials were administered.

Results Clinical improvement was seen immediately after surgery. Complete return to previous activity level was observed 12 months after surgery. Follow-up radiographs 18 months after the procedure revealed no implant migration.

Clinical Significance The gentamicin-impregnated PMMA plug in addition to the surgical debridement seemed to be an effective way for short-term distraction, potentially contributing, along with the appropriate antimicrobial therapy and analgesia, to alleviation of pain immediately after surgery and providing for a good short-term outcome, in this clinical case. The use of cement plugs as sole devices in the LS joint warrants further study.

Keywords

dog - lumbosacral discospondylitis - ventral slot - gentamicin-impregnated PMMA plug - omentalization

^* Culture and sensitivity testing were reported to have been performed, at the referral practice. However, the results were not communicated to the authors of the study.

Author Contributions

Pierre Henri Moissonnier contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Maria Manou contributed to study design, acquisition of data and data analysis and interpretation. Aurélien Jeandel and Stéphane Blot contributed to acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

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