European Spine Journal

, Volume 28, Issue 4, pp 768–774 | Cite as

Sonication of removed implants improves microbiological diagnosis of postoperative spinal infections

  • Justus Bürger
  • Doruk Akgün
  • Patrick Strube
  • Michael PutzierEmail author
  • Matthias Pumberger
Original Article



In total joint replacement, culturing of the sonication fluid of removed implants has proven to be more sensitive than conventional periprosthetic tissue culture for the microbiological diagnosis of prosthetic joint infection. However, its role in postoperative spinal implant infection (PSII) is not well investigated. Therefore, the aim of this study was to determine the validity of sonication in detecting infection following instrumented spine surgery.


In this prospective controlled consecutive cohort study, patients undergoing spinal revision between September 2016 and March 2018 were analyzed. In all patients sonication of removed spinal implants and at least one peri-implant tissue culture were performed. Demographic data, including age, gender, clinical manifestation, comorbidities, laboratory values (CRP and blood leukocytes), were recorded. Microorganisms causing PSII were documented. Sensitivity and specificity of sonication and peri-implant tissue culture were evaluated.


A total of 118 patients were included. PSII was diagnosed in 35 patients, representing 29.6% of the study cohort. Sensitivities of tissue and sonication fluid culture were 65.7% (95% confidence interval (CI) 48.6–80.0) and 94.3% (95% CI 85.7–100) (p value = 0.002) and specificities 96.4% (95% CI 91.6–100) and 98.8% (95% CI 96.4–100), respectively. The most common microorganisms found in PSII were coagulase-negative Staphylococci and Propionibacterium acnes. Eleven PSIIs were detected only by sonicate fluid culture.


Culture of samples obtained by spinal implant sonication was more sensitive than conventional peri-implant tissue culture for the microbiological diagnosis of PSII. Therefore, sonication should be used as a routine tool in the diagnostic workup of PSII.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Sonication Infection Diagnosis Spine Low virulence 


Compliance with ethical standards

Conflict of interest

No conficts of interest for the current study.

Supplementary material

586_2019_5881_MOESM1_ESM.pptx (140 kb)
Supplementary material 1 (PPTX 140 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Justus Bürger
    • 1
  • Doruk Akgün
    • 1
  • Patrick Strube
    • 2
  • Michael Putzier
    • 1
    Email author
  • Matthias Pumberger
    • 1
  1. 1.Charité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Orthopedic DepartmentUniversity Hospital JenaEisenbergGermany

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