{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:25:03Z","timestamp":1793147103960,"version":"4.5.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T00:00:00Z","timestamp":1610150400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T00:00:00Z","timestamp":1610150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Surgical intervention with intercorporal stabilisation in spinal infections is increasingly needed. Our aim was to compare titanium and polyetheretherketon (PEEK) cages according to their adhesion characteristics of different bacteria species in vitro.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Plates made from PEEK, polished titanium (Ti), two-surface-titanium (TiMe) (<jats:italic>n<\/jats:italic>\u2009=\u20092\u20133) and original PEEK and porous trabecular structured titanium (TiLi) interbody cages (<jats:italic>n<\/jats:italic>\u2009=\u20094) were inoculated in different bacterial solutions, <jats:italic>S.aureus (<\/jats:italic>MSSA<jats:italic>,<\/jats:italic> MRSA<jats:italic>), S.epidermidis<\/jats:italic> and <jats:italic>E.coli<\/jats:italic>. Growth characteristics were analysed. Biofilms and bacteria were visualised using confocal- and electron microscopy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Quantitative adherence of MSSA, MRSA, <jats:italic>S.epidermidis<\/jats:italic> and <jats:italic>E.coli<\/jats:italic> to Ti, TiMe and PEEK plates were different, with polished titanium being mainly advantageous over PEEK and TiMe with significantly less counts of colony forming units (CFU) for MRSA after 56\u00a0h compared to TiMe and at 72\u00a0h compared to PEEK (<jats:italic>p<\/jats:italic>\u2009=\u20090.04 and <jats:italic>p<\/jats:italic>\u2009=\u20090.005). For MSSA, more adherent bacteria were detected on PEEK than on TiMe at 32\u00a0h (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). For PEEK and TiLi cages, significant differences were found after 8 and 72\u00a0h for <jats:italic>S.epidermidis<\/jats:italic> (<jats:italic>p<\/jats:italic>\u2009=\u20090.02 and p\u2009=\u20090.008) and after 72\u00a0h for MSSA (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) with higher bacterial counts on PEEK, whereas <jats:italic>E.coli<\/jats:italic> showed more CFU on TiLi than PEEK (<jats:italic>p<\/jats:italic>\u2009=\u20090.05). Electron microscopy demonstrated enhanced adhesion in transition areas.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>For <jats:italic>S.epidermidis<\/jats:italic>, MSSA and MRSA PEEK cages showed a higher adherence in terms of CFU count, whereas for <jats:italic>E.coli<\/jats:italic> PEEK seemed to be advantageous. Electron microscopic visualisation shows that bacteria did not adhere at the titanium mesh structure, but at the border zones of polished material to rougher parts.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-020-06705-z","type":"journal-article","created":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T18:34:14Z","timestamp":1610217254000},"page":"1774-1782","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Bacterial adhesion characteristics on implant materials for intervertebral cages: titanium or PEEK for spinal infections?"],"prefix":"10.1007","volume":"30","author":[{"given":"Theresa","family":"Kr\u00e4tzig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus Christian","family":"Mende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Mohme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"von Kroge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Stangenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Dreimann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Westphal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Weisselberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven Oliver","family":"Eicker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,9]]},"reference":[{"key":"6705_CR1","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.jinf.2013.11.011","volume":"68","author":"M Kehrer","year":"2014","unstructured":"Kehrer M, Pedersen C, Jensen TG, Lassen AT (2014) Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 68:313\u2013320. https:\/\/doi.org\/10.1016\/j.jinf.2013.11.011","journal-title":"J Infect"},{"key":"6705_CR2","doi-asserted-by":"publisher","first-page":"254.e1","DOI":"10.1016\/j.cmi.2014.09.007","volume":"21","author":"O Murillo","year":"2015","unstructured":"Murillo O, Grau I, Lora-Tamayo J et al.(2015) The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect 21:254.e1-254.e8. https:\/\/doi.org\/10.1016\/j.cmi.2014.09.007","journal-title":"Clin Microbiol Infect"},{"key":"6705_CR3","doi-asserted-by":"publisher","first-page":"342","DOI":"10.3171\/2012.7.SPINE12203","volume":"17","author":"SM Kurtz","year":"2012","unstructured":"Kurtz SM, Lau E, Ong KL et al.(2012) Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population. J Neurosurg Spine 17:342\u2013347. https:\/\/doi.org\/10.3171\/2012.7.SPINE12203","journal-title":"J Neurosurg Spine"},{"key":"6705_CR4","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1097\/01.brs.0000261034.83395.7f","volume":"32","author":"M Ruf","year":"2007","unstructured":"Ruf M, Stoltze D, Merk HR et al.(2007) Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages. Spine 32:275\u2013280. https:\/\/doi.org\/10.1097\/01.brs.0000261034.83395.7f","journal-title":"Spine"},{"key":"6705_CR5","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1080\/17453670810016687","volume":"79","author":"Y Robinson","year":"2008","unstructured":"Robinson Y, Tschoeke SK, Finke T et al.(2008) Successful treatment of spondylodiscitis using titanium cages: a 3-year follow-up of 22 consecutive patients. Acta Orthop 79:660\u2013664. https:\/\/doi.org\/10.1080\/17453670810016687","journal-title":"Acta Orthop"},{"key":"6705_CR6","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.clineuro.2014.09.027","volume":"127","author":"M Schomacher","year":"2014","unstructured":"Schomacher M, Finger T, Koeppen D et al.(2014) Application of titanium and polyetheretherketone cages in the treatment of pyogenic spondylodiscitis. Clin Neurol Neurosurg 127:65\u201370. https:\/\/doi.org\/10.1016\/j.clineuro.2014.09.027","journal-title":"Clin Neurol Neurosurg"},{"key":"6705_CR7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13037-015-0083-4","volume":"9","author":"SK Tsch\u00f6ke","year":"2015","unstructured":"Tsch\u00f6ke SK, Fuchs H, Schmidt O et al.(2015) Single-stage debridement and spinal fusion using PEEK cages through a posterior approach for eradication of lumbar pyogenic spondylodiscitis: a safe treatment strategy for a detrimental condition. Patient Saf Surg 9:35. https:\/\/doi.org\/10.1186\/s13037-015-0083-4","journal-title":"Patient Saf Surg"},{"key":"6705_CR8","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1007\/s00701-016-2924-z","volume":"158","author":"E Shiban","year":"2016","unstructured":"Shiban E, Janssen I, da Cunha PR et al.(2016) Safety and efficacy of polyetheretherketone (PEEK) cages in combination with posterior pedicel screw fixation in pyogenic spinal infection. Acta Neurochir (Wien) 158:1851\u20131857. https:\/\/doi.org\/10.1007\/s00701-016-2924-z","journal-title":"Acta Neurochir (Wien)"},{"key":"6705_CR9","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1053\/sarh.2002.29492","volume":"31","author":"JM Nolla","year":"2002","unstructured":"Nolla JM, Ariza J, G\u00f3mez-Vaquero C et al.(2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31:271\u2013278. https:\/\/doi.org\/10.1053\/sarh.2002.29492","journal-title":"Semin Arthritis Rheum"},{"key":"6705_CR10","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2008.0181","author":"R Sobottke","year":"2008","unstructured":"Sobottke R, Seifert H, F\u00e4tkenheuer G et al.(2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Aerzteblatt Online. https:\/\/doi.org\/10.3238\/arztebl.2008.0181","journal-title":"Dtsch Aerzteblatt Online"},{"key":"6705_CR11","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1007\/s00590-016-1803-x","volume":"26","author":"P Korovessis","year":"2016","unstructured":"Korovessis P, Vardakastanis K, Fennema P, Syrimbeis V (2016) Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? a systematic review of literature over a decade. Eur J Orthop Surg Traumatol 26:753\u2013761. https:\/\/doi.org\/10.1007\/s00590-016-1803-x","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"6705_CR12","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1093\/cid\/civ482","volume":"61","author":"EF Berbari","year":"2015","unstructured":"Berbari EF, Kanj SS, Kowalski TJ et al.(2015) 2015 Infectious diseases society of america (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 61:e26\u2013e46. https:\/\/doi.org\/10.1093\/cid\/civ482","journal-title":"Clin Infect Dis"},{"key":"6705_CR13","doi-asserted-by":"publisher","first-page":"087","DOI":"10.1055\/s-0032-1320022","volume":"74","author":"C St\u00fcer","year":"2013","unstructured":"St\u00fcer C, Stoffel M, Hecker J et al.(2013) A staged treatment algorithm for spinal infections. J Neurol Surg Part A Cent Eur Neurosurg 74:087\u2013095. https:\/\/doi.org\/10.1055\/s-0032-1320022","journal-title":"J Neurol Surg Part A Cent Eur Neurosurg"},{"key":"6705_CR14","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.colsurfb.2013.09.012","volume":"113","author":"ETJ Rochford","year":"2014","unstructured":"Rochford ETJ, Poulsson AHC, Salavarrieta Varela J et al.(2014) Bacterial adhesion to orthopaedic implant materials and a novel oxygen plasma modified PEEK surface. Coll Surf B Biointerfaces 113:213\u2013222. https:\/\/doi.org\/10.1016\/j.colsurfb.2013.09.012","journal-title":"Coll Surf B Biointerfaces"},{"key":"6705_CR15","doi-asserted-by":"publisher","first-page":"4829","DOI":"10.2147\/IJN.S35190","volume":"7","author":"S Bal","year":"2012","unstructured":"Bal S, Gorth D, Puckett S et al.(2012) Decreased bacteria activity on Si3N4 surfaces compared with PEEK or titanium. Int J Nanomed 7:4829\u20134840. https:\/\/doi.org\/10.2147\/IJN.S35190","journal-title":"Int J Nanomed"},{"key":"6705_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s12859-017-1934-z","author":"CT Rueden","year":"2017","unstructured":"Rueden CT, Schindelin J, Hiner MC et al.(2017) Image J2: imageJ for the next generation of scientific image data. BMC Bioinformatics. https:\/\/doi.org\/10.1186\/s12859-017-1934-z","journal-title":"BMC Bioinformatics"},{"key":"6705_CR17","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jbspin.2006.11.002","volume":"74","author":"F Grados","year":"2007","unstructured":"Grados F, Lescure FX, Senneville E et al.(2007) Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Jt bone spine 74:133\u2013139. https:\/\/doi.org\/10.1016\/j.jbspin.2006.11.002","journal-title":"Jt bone spine"},{"key":"6705_CR18","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/femsre\/fuy001","volume":"42","author":"Y Ren","year":"2018","unstructured":"Ren Y, Wang C, Chen Z et al.(2018) Emergent heterogeneous microenvironments in biofilms: substratum surface heterogeneity and bacterial adhesion force-sensing. FEMS Microbiol Rev 42:259\u2013272. https:\/\/doi.org\/10.1093\/femsre\/fuy001","journal-title":"FEMS Microbiol Rev"},{"key":"6705_CR19","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s10295-007-0234-4","volume":"34","author":"J Palmer","year":"2007","unstructured":"Palmer J, Flint S, Brooks J (2007) Bacterial cell attachment, the beginning of a biofilm. J Ind Microbiol Biotechnol 34:577\u2013588. https:\/\/doi.org\/10.1007\/s10295-007-0234-4","journal-title":"J Ind Microbiol Biotechnol"},{"key":"6705_CR20","doi-asserted-by":"publisher","first-page":"2787","DOI":"10.1007\/s00586-013-2850-1","volume":"22","author":"RM Duarte","year":"2013","unstructured":"Duarte RM, Vaccaro AR (2013) Spinal infection: state of the art and management algorithm. Eur Spine J 22:2787\u20132799. https:\/\/doi.org\/10.1007\/s00586-013-2850-1","journal-title":"Eur Spine J"},{"key":"6705_CR21","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1126\/science.284.5418.1318","volume":"284","author":"JW Costerton","year":"1999","unstructured":"Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial biofilms: a common cause of persistent infections. Science 284:1318\u20131322. https:\/\/doi.org\/10.1126\/science.284.5418.1318","journal-title":"Science"},{"key":"6705_CR22","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1038\/s41579-018-0019-y","volume":"16","author":"CR Arciola","year":"2018","unstructured":"Arciola CR, Campoccia D, Montanaro L (2018) Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol 16:397\u2013409. https:\/\/doi.org\/10.1038\/s41579-018-0019-y","journal-title":"Nat Rev Microbiol"},{"key":"6705_CR23","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s10856-007-0143-0","volume":"18","author":"LG Harris","year":"2007","unstructured":"Harris LG, Meredith DO, Eschbach L, Richards RG (2007) Staphylococcus aureus adhesion to standard micro-rough and electropolished implant materials. J Mater Sci Mater Med 18:1151\u20131156. https:\/\/doi.org\/10.1007\/s10856-007-0143-0","journal-title":"J Mater Sci Mater Med"},{"key":"6705_CR24","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/j.biomaterials.2010.10.001","volume":"32","author":"Y Wu","year":"2011","unstructured":"Wu Y, Zitelli JP, TenHuisen KS et al.(2011) Differential response of Staphylococci and osteoblasts to varying titanium surface roughness. Biomaterials 32:951\u2013960. https:\/\/doi.org\/10.1016\/j.biomaterials.2010.10.001","journal-title":"Biomaterials"},{"key":"6705_CR25","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1038\/s41579-018-0057-5","volume":"16","author":"C Berne","year":"2018","unstructured":"Berne C, Ellison CK, Ducret A, Brun YV (2018) Bacterial adhesion at the single-cell level. Nat Rev Microbiol 16:616\u2013627. https:\/\/doi.org\/10.1038\/s41579-018-0057-5","journal-title":"Nat Rev Microbiol"},{"key":"6705_CR26","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jcma.2017.07.012","volume":"81","author":"M Jamal","year":"2018","unstructured":"Jamal M, Ahmad W, Andleeb S et al.(2018) Bacterial biofilm and associated infections. J Chin Med Assoc 81:7\u201311. https:\/\/doi.org\/10.1016\/j.jcma.2017.07.012","journal-title":"J Chin Med Assoc"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-020-06705-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-020-06705-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-020-06705-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T17:07:07Z","timestamp":1626282427000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-020-06705-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,9]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["6705"],"URL":"https:\/\/doi.org\/10.1007\/s00586-020-06705-z","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,9]]},"assertion":[{"value":"31 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors have any potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}