Low-grade infection due to annular closure device
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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  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. , 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  for hip and knee replacements.
Shiban and Meyer.