Acta Neurochirurgica

, Volume 160, Issue 9, pp 1867–1867 | Cite as

Low-grade infection due to annular closure device

  • Nicole LangeEmail author
  • Bernhard Meyer
  • Ehab Shiban
Letter to the Editor (by Invitation) - Infection
Part of the following topical collections:
  1. Infection

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.


  1. 1.
    Lange N, Meyer B, Shiban E (2017) Symptomatic annulus-repair-device loosening due to a low-grade infection. Acta Neurochir 160:199–203CrossRefPubMedGoogle Scholar
  2. 2.
    Krutko AV, Baykov ES, Sadovoy MA (2016) Reoperation after microdiscectomy of lumbar herniation: case report. Int J Surg Case Rep 24:119–123CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    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):654–663CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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