TO THE EDITOR

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TO THE EDITOR:
Re:Spinal Implants Can be Inserted in Patients With Deep Spine Infection - Results from a Large Cohort Study. Hey HW, Hwee Weng Dennis H, Chuen Seng T, et al. Spine 2016 Jun 21 [Epub ahead of print]
We read with great interest recent article by Hey et al1 on the safety of spinal implant insertion in patients with pyogenic vertebral osteomyelitis. Some additional information would be helpful for readers to appreciate the safety of instrumentation in spinal infection. First, does three groups have comparable baseline demographics or similar pathogens? Owing to the nature of retrospective study, this analysis can be difficult, but these information help readers understand better. Second, can you explain detailed clinical or radiological suspicion of instability for surgical decision making? It will be an important standard to decide whether to operate or not. Third, among Staphylococcus aureus-infected cases, how many were caused by methicillin-resistant S aureus (MRSA)? In some institutions, MRSA is a common cause of vertebral osteomyelitis and is associated with higher recurrence rates.2 Fourth, for how long did the patients receive antibiotics after surgery? In our recent study, recurrence was not associated with spinal instrumentation, but it was associated with a shorter duration (<6 weeks) of antibiotic therapy.3 Finally, in case of instrumentations, what kind of fusion materials were used? (e.g., cage or not, autobone or not, among others). According to our previous study, autobone type or preparation procedure could be one of the influencing factors for postoperative spinal infection.

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