How would you manage and determine the duration of antibiotics for a patient with suspected chronic postoperative spinal implant infection, status post lumbar fusion, now presenting with loosened hardware on imaging, normal inflammatory markers, and no systemic infection symptoms?

Loosening can be identified as lucency around pedicle screws on standard radiography, commonly at the upper or lower ends of the surgical construct. It was graded on a scale of 0-3. High-grade loosening (grade 2 or 3) is associated with increased odds of requiring revision surgery. It can be mechanical or can be related to low-grade chronic infection, especially in the context of high-grade loosening, with 29%-42% of patients with positive culture results per evidence.

The management of such pat...

Follow-up: The patient is 8 weeks status post (s/p) revision of non-union. The decision post-op was to withhold antibiotics pending cultures. All intra-operative cultures for bacteria, fungi, and mycobacteria have been finalized with no growth. The patient is clinically improved and increasingly mobile. The non-union of the 2019 hardware appears not to have been infectious in nature.

PET scan, molecular-based. Microbial detection (eg., WGS, etc). If negative or equivocal, repeat all in 4-6 months.