Skip to main content

Advertisement

SpringerLink
Log in

Locally Used Antibiotics for Spinal Infection Prophylaxis and Their Effects on Epidural Fibrosis: an Experimental Laminectomy Study in Rats Using Rifamycin and Gentamycin

  • ORIGINAL ARTICLE
  • Published:
Inflammation Aims and scope Submit manuscript

Abstract

The study aims to assess the effects of antibiotics (ABs), which are typically used in spinal infection prophylaxis, on the formation of epidural fibrosis (EF). Specifically, we investigated the effect of rifamycin and gentamycin on EF formation in laminectomized rats. Thirty-two rats were randomly and equally divided into four groups as follows: laminectomy and physiological saline (0.9% NaCl) solution (control); laminectomy and rifamycin; laminectomy and gentamicin; and laminectomy and a mixture of rifamycin and gentamicin. Laminectomy was performed on L1 and L2 vertebrae in all rats. One month after spinal surgery, spinal tissue samples surrounding the laminectomy were cut with a microtome and stained with hematoxylin-eosin and Masson’s trichrome. The histopathological analysis included examining the extent of EF, fibroblast cell density, and cartilage and bone regeneration. Statistical analysis was performed using the IBM SPSS Statistics 22 program (SPSS IBM, Turkey). A value of p < 0.05 was considered statistically significant. EF value differences between the AB treatment groups and the control group were statistically significant (p = 0.030). Specifically, binary comparisons indicated that the EF value was significantly higher in the rifamycin group than that in the control group (p = 0.003; p < 0.05). Our study suggests that locally applied ABs, especially rifamycin, should be diluted before administration to the epidural space.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sebaaly, A., M.J. Lahoud, M. Rizkallah, G. Kreichati, and K. Kharrat. 2018. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine Journal 12: 574–585.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Xu, J., Y. Chen, Y. Yue, J. Sun, and L. Cui. 2012. Reconstruction of epidural fat with engineered adipose tissue from adipose derived stem cells and PLGA in the rabbit dorsal laminectomy model. Biomaterials 33: 6965–6973.

    Article  CAS  PubMed  Google Scholar 

  3. Zhang, C., X. Kong, C. Liu, Z. Liang, H. Zhao, W. Tong, G. Ning, W. Shen, L. Yao, and S. Feng. 2014. ERK2 small interfering RNAs prevent epidural fibrosis via the efficient inhibition of collagen expression and inflammation in laminectomy rats. BiochemBiophys Res Commun 444: 395–400.

    Article  CAS  Google Scholar 

  4. Chan, C.W., and P. Peng. 2011. Failed back surgery syndrome. Pain Medicine 12: 577–606.

    Article  PubMed  Google Scholar 

  5. Wang, H., W. Sun, D. Fu, Y. Shen, Y.Y. Chen, and L.L. Wang. 2018. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy. Journal Orthopaedic Translation 13: 41–49.

    Article  CAS  Google Scholar 

  6. Sun, Y., S. Zhao, X. Li, L. Yan, J. Wang, D. Wang, et al. 2016. Local application of rapamycin reduces epidural fibrosis after laminectomy via inhibiting fibroblast proliferation and prompting apoptosis. Journal of Orthopaedic Surgery and Research 11: 58.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang, X., H. Tao, Y. Zhu, X. Lu, and X. Hu. 2015. Management of Postoperative Spondylodiscitis with and without internal fixation. Turkish Neurosurgery 25: 513–518.

    PubMed  Google Scholar 

  8. Godil, S.S., S.L. Parker, K.R. O'Neill, C.J. Devin, and M.J. McGirt. 2013. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. Journal of Neurosurgery. Spine 19: 331–335.

    Article  PubMed  Google Scholar 

  9. Huyskens, J., J. Van Goethem, M. Faure, L. van den Hauwe, F. De Belder, C. Venstermans, et al. 2015. Overview of the complications and sequelae in spinal infections. Neuroimaging Clinics of North America 25: 309–321.

    Article  PubMed  Google Scholar 

  10. Kërveshi, A., N. Halili, B. Kastrati, F. Qosja, S. Kabashi, and S. Muçaj. 2014. Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery. Mater Sociomed 26: 398–400.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tali, E.T., A.Y. Oner, and A.M. Koc. 2015. Pyogenic spinal infections. Neuroimaging Clinics of North America 25: 193–208.

    Article  PubMed  Google Scholar 

  12. Gerometta, A., F. Bittan, and J.C. Rodriguez Olaverri. 2012. Postoperative spondilodiscitis. IntOrthop 36: 433–438.

    Google Scholar 

  13. McDermott, H., C. Bolger, and H. Humphreys. 2012. Postprocedural discitis of the vertebral spine: Challenges in diagnosis, treatment and prevention. The Journal of Hospital Infection 82: 152–157.

    Article  CAS  PubMed  Google Scholar 

  14. Yoon, S.H., S.K. Chung, K.J. Kim, H.J. Kim, Y.J. Jin, and H.B. Kim. 2010. Pyogenic vertebral osteomyelitis: Identification of microorganism and laboratory markers used to predict clinical outcome. European Spine Journal 19: 575–582.

    Article  PubMed  Google Scholar 

  15. Alt, V. 2017. Antimicrobial coated implants in trauma and orthopaedics-A clinical review and risk-benefit analysis. Injury 48: 599–607.

    Article  PubMed  Google Scholar 

  16. Chang, Y., C.L. Tai, P.H. Hsieh, and S.W. Ueng. 2013. Gentamicin in bone cement: A potentially more effective prophylactic measure of infection in joint arthroplasty. Bone Joint Research 2: 220–226.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gulcu, A., A. Akman, A.F. Demirkan, A.C. Yorukoglu, I. Kaleli, and F. Bir. 2016. Fosfomycin addition to poly(D, L-lactide) coating does not affect prophylaxis efficacy in rat implant-related infection model, but that of gentamicin does. PLoS One 11: e0165544.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kaya, I., I. Sungur, M. Yılmaz, F. Pehlivanoğlu, K. Kartyaşar, and G. Sengöz. 2013. Comparison of the efficiency of different antibiotic irrigation solutions in decontamination of allografts contaminated with Staphylococcus aureus. ActaOrthopTraumatolTurc 2013 47: 281–285.

    Google Scholar 

  19. Kittinger, C., E. Marth, R. Windhager, A.M. Weinberg, G. Zarfel, and R. Baumert. 2011. Antimicrobial activity of gentamicin palmitate against high concentrations of Staphylococcus aureus. Journal of Materials Science. Materials in Medicine 22: 1447–1453.

    Article  CAS  PubMed  Google Scholar 

  20. Konstantelias, A.A., K.A. Polyzos, and M.E. Falagas. 2016. Gentamicin-collagen sponges for the prevention of surgical site infections: A meta-analysis of randomized controlled trials. Surgical Infections 17: 601–609.

    Article  PubMed  Google Scholar 

  21. Lee, K.H., T.B. Tan, and K. Mossinac. 2008. Systemic absorption of gentamicin irrigation in joint replacement surgery: A cause of concern. Malaysian Orthopaedic Journal 2: 11–16.

    Article  Google Scholar 

  22. Mastronardi, L., F. Rychlicki, C. Tatta, L. Morabito, U. Agrillo, and A. Ducati. 2005. Spondylodiscitis after lumbar microdiscectomy: Effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases. Neurosurgical Review 28: 303–307.

    Article  PubMed  Google Scholar 

  23. Philp, A.M., S. Raja, A. Philp, M.P. Newton Ede, and S.W. Jones. 2017. The effect of vancomycin and gentamicin antibiotics on human osteoblast proliferation, metabolic function, and Bone Mineralization. Spine (Phila Pa 1976) 42: 202–207.

    Article  Google Scholar 

  24. Rapetto, F., V.D. Bruno, G. Guida, R. Marsico, P. Chivasso, and C. Zebele. 2016. Gentamicin-impregnated collagen sponge: Effectiveness in preventing sternal wound infection in high-risk cardiac surgery. Drug Target Insights 10 (Suppl 1): 9–13.

    PubMed  PubMed Central  Google Scholar 

  25. Srisung, W., J. Teerakanok, P. Tantrachoti, A. Karukote, and K. Nugent. 2017. Surgical prophylaxis with gentamicin and acute kidney injury: A systematic review and meta-analysis. Annals of Translational Medicine 5: 100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. He, Y., M. Revel, and B. Loty.1995. A quantitative model of post-laminectomy scar formation. Effects of a nonsteroidal anti-inflammatory drug. Spine (Phila Pa 1976) 20:557–563; discussion 579-80.

  27. Kalakoti, P., S. Missios, T. Maiti, S. Konar, S. Bir, P. Bollam, S. Konar, S. Bir, P. Bollam, and A. Nanda. 2016. Inpatient outcomes and postoperative complications after primary versus revision lumbar spinal fusion surgeries for degenerative lumbar disc disease: A National (Nationwide) Inpatient Sample Analysis, 2002-2011. World Neurosurgery 85: 114–124.

    Article  PubMed  Google Scholar 

  28. Molinari, R.W., O.A. Khera, and W.J. Molinari 3rd. 2012. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J 21 Suppl 4: S476–82.

  29. Whiteside, L.A.2016. Prophylactic peri-operative local antibiotic irrigation. Bone Joint Journal 98-B(1 Suppl A):23–26.

  30. Hanssen, A.D., D.R. Osmon, and R. Patel. 2005. Local antibiotic delivery systems: Where are we and where are we going? Clinical Orthopaedics and Related Research (437): 111–114.

  31. Tubaki, V.R., S. Rajasekaran, and A.P. Shetty. 2013. Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976) 38: 2149–2155.

    Article  Google Scholar 

  32. Cai, H.X., C. Liu, and S.W. Fan. 2011. Routinely using prophylactic antibiotic may not effectively prevent intervertebral disc infection: A new strategy to preventing postoperative intervertebral disc infection. Medical Hypotheses 76: 464–466.

    Article  PubMed  Google Scholar 

  33. Benfer, J., and H. Struck. 1976. The effect of rifamycin SV on the wound-healing process. Arzneimittelforschung 26: 1361–1364.

    CAS  PubMed  Google Scholar 

  34. Gurel, M.S., S. Naycı, A.V. Turgut, and E.R. Bozkurt. 2015. Comparison of the effects of topical fusidic acid and rifamycin on wound healing in rats. International Wound Journal 12: 106–110.

    Article  PubMed  Google Scholar 

  35. Cardot, E., I. Tillie-Leblond, P. Jeannin, A. Facon, K. Breuil, F. Patte, and A.B. Tonnel. 1995. Anaphylactic reaction to local administration of rifamycin SV. The Journal of Allergy and Clinical Immunology 95: 1–7.

    Article  CAS  PubMed  Google Scholar 

  36. Scarpignato, C., and I. Pelosini. 2005. Rifaximin, a poorly absorbed antibiotic: Pharmacology and clinical potential. Chemotherapy 51 (Suppl 1): 36–66.

    Article  CAS  PubMed  Google Scholar 

  37. Caruso, I. 1997. Twenty years of experience with intra-articular rifamycin for chronic arthritides. Journal of International Medical Research 25: 307–317.

    Article  CAS  PubMed  Google Scholar 

  38. Rosette, C., F. Buendia-Laysa Jr., S. Patkar, L. Moro, G. Celasco, and R. Bozzella. 2013. Anti-inflammatory and immunomodulatory activities of rifamycin SV. International Journal of Antimicrobial Agents 42 (2): 182–186.

    Article  CAS  PubMed  Google Scholar 

  39. Shah, J.M., E. Omar, D.R. Pai, and S. Sood. 2012. Cellular events and biomarkers of wound healing. Indian Journal Plastic Surgery 45: 220–228.

    Article  Google Scholar 

  40. O'Meara, S.M., N.A. Cullum, M. Majid, and T.A. Sheldon. 2001. Systematic review of antimicrobial agents used for chronic wounds. The British Journal of Surgery 88: 4–21.

    Article  CAS  PubMed  Google Scholar 

  41. Key, J.A., and L.T. Ford. 1948. Experimental intervertebral-disc lesions. The Journal of Bone and Joint Surgery. American Volume 30A: 621–630.

    Article  CAS  PubMed  Google Scholar 

  42. LaRocca, H., and I. Macnab. 1974. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. Journal of Bone and Joint Surgery. British Volume (London) 56B: 545–550.

    Article  CAS  Google Scholar 

  43. Songer, M.N., L. Ghosh, and D.L. Spencer. 1990. Effects of sodium hyaluronate on peridural fibrosis after lumbar laminotomy and discectomy. Spine (Phila Pa 1976) 15: 550–554.

    Article  CAS  Google Scholar 

  44. van Raaij, T.M., L.E. Visser, A.G. Vulto, and J.A. Verhaar. 2002. Acute renal failure after local gentamicin treatment in an infected total knee arthroplasty. The Journal of Arthroplasty 17: 948–950.

    Article  PubMed  Google Scholar 

Download references

Funding

The present study was supported partly by the revolving fund of the Istanbul Fatih Sultan Mehmet Education and Research Hospital at the University of Health Sciences.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, E-5 Karayolu Uzeri, 34752, İcerenkoy-Atasehir, Istanbul, Turkey

    Nese Keser & Merih Is

  2. Department of Neurological Surgery, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Duygu Ceman

  3. Department of Pathology, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Adnan Somay

Authors
  1. Nese Keser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Merih Is
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Duygu Ceman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adnan Somay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nese Keser.

Ethics declarations

Ethical Approval

“All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.”

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keser, N., Is, M., Ceman, D. et al. Locally Used Antibiotics for Spinal Infection Prophylaxis and Their Effects on Epidural Fibrosis: an Experimental Laminectomy Study in Rats Using Rifamycin and Gentamycin. Inflammation 42, 714–720 (2019). https://doi.org/10.1007/s10753-018-0929-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10753-018-0929-x

Key Words

Search

Navigation