Experience with Bioactive Glass S53P4 (BAG-S53P4) Granule Implantation During the Surgical Management of Spinal Infection: Single-center Case Series of 19 Patients and Brief Review of Literature.

Abstract

Intentional implantation of surgical materials during the treatment of spinal infections remains controversial. Bioactive glass S53P4 (BAG-SP53P4) is a commercially available material with osteoconductive and antimicrobial properties, but data on safety and complications during spinal infection treatment is limited. The authors retrospectively examined cases of patients at the Royal Brisbane and Women's Hospital between 2018 and 2021 who underwent surgical treatment of spinal infections with BAGSP53P4 granule implantation. Descriptive analysis of patient and infection characteristics, as well as radiographic fusion rates, are reported. Nineteen patients were included, with a mean age of 61 years and a 68% male preponderance. Discitis was diagnosed alone or in combination with another form of spinal infection in 15 cases (79%), infected metalwork was present in 5 cases (26%), and epidural abscess was present in 1 case (5%). A single bacterial organism was cultured in 17 cases. BAG-SP53P4 was placed in posterolateral gutters or around metalware in 39% of cases, disc space in 30%, within corpectomy cage in 17% and interbody cage in 13%. Revision surgery was required in 2 cases-one with persisting infection and one with progressive mechanical instability needing instrumentation. Follow-up ranged between 83 and 1205 days and radiographic fusion was evident for 6 cases (32%) at mean duration of 8.6 months. This is the largest study investigating BAG-SP53P4 implantation in the setting of spinal infections. BAG-SP53P4 implantation is safe in spine infection surgery, but its putative effects on infection eradication and promoting arthrodesis requires further study.