Implantatversagen aufgrund von Infekt/Low-grade Infekt – Ursachen und Behandlungskonzepte

Zusammenfassung

Implantatversagen im Sinne von Implantatlockerungen sind eine regelmäßige Komplikation spinaler Instrumentierungen. Die Ursachen von Implantatlockerungen sind oft aseptisch. Allerdings zeigen eine Reihe jüngerer Studien, dass Infektionen, insbesondere „low-grade“ Infektionen für einen relevanten Anteil der Implantatlockerungen ursächlich sind. Diese Infekt-bedingten Implantatlockerungen bedürfen einer angepassten Strategie im Hinblick auf Diagnostik und Therapie. Zur sicheren Diagnostik Infekt-bedingter Lockerungen sind Sonikate der Implantate notwendig. Die Implantatentfernung oder ein -tausch bei Lockerung sollte von einer angepassten Antibiotikatherapie begleitet sein.

Abstract

Loosening/failure of spinal implants is a regular complication of spinal instrumentation. Reasons for implant loosening are often aseptic. However, recent data reveal that infections as a source of spinal implant failure have been underestimated and are a common reason for screw loosening. Especially delayed low-grade infections are a typical cause and require special diagnostic procedures to identify the underlying infection. The diagnostic workup includes a sonication of removed implants to unmask microorganisms protected in biofilms. Unreplaced removal of contaminated implants or an implant exchange and an adjusted antibiotic therapy are necessary in the treatment of these low-grade infections.

Schlüsselwörter

Implantat-assoziierte Infektionen - Implantatlockerungen - Implantatversagen - Low-grade Infektionen - Pedikelschrauben - Pseudarthrose

Keywords

Implant-associated infections - implant loosening - implant failure - low-grade infections, pedicle screws - pseudarthrosis

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