Dear Editor,
In response to the letter from Dr. Krutko, we would like to emphasize that bone resorption surrounding a spinal implant is not unique and has been already published in many other series before.
The key message of our case report [1] was the presence of a proven low-grade infection, which is still an underestimated cause of formerly described “aseptic implant failures.”
As such, the cases are different. In the case reported by Krutko et al. [2], the patient suffered from these bone changes 1 month following surgery. Therefore, this was probably not a low-grade infection which is usually present with a latency of a few years after surgery. To rule out a low-grade infection, 14-day cultures of implant sonification fluid would have been necessary.
With our case report, we want to raise awareness for low-grade infections and advocate for the use of 14-day culture from sonification fluid from the removed implant as it is established by the seminal article of Trampusz [3] for hip and knee replacements.
Best regards,
Shiban and Meyer.
References
Lange N, Meyer B, Shiban E (2017) Symptomatic annulus-repair-device loosening due to a low-grade infection. Acta Neurochir 160:199–203
Krutko AV, Baykov ES, Sadovoy MA (2016) Reoperation after microdiscectomy of lumbar herniation: case report. Int J Surg Case Rep 24:119–123
Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357(7):654–663
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Lange, N., Meyer, B. & Shiban, E. Low-grade infection due to annular closure device. Acta Neurochir 160, 1867 (2018). https://doi.org/10.1007/s00701-018-3611-z
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DOI: https://doi.org/10.1007/s00701-018-3611-z