Strategies for the Prevention and Treatment of Surgical Site Infection in the Lumbar Spine

Abstract

Surgical site infection (SSI) following spine surgery can be devastating for both the patient and the surgeon. It leads to significant morbidity and associated health care costs, from readmissions, reoperations, and subsequent poor clinical outcomes. Complications associated with SSI following spine surgery include pseudarthrosis, neurological deterioration, sepsis, and death. Its management can be very challenging. The diagnosis of SSI involves the interpretation of combined clinical, laboratory, and occasionally radiologic findings. Most infections can be treated with an appropriate course of antibiotics and bracing if required. Surgical intervention is usually reserved for infections resistant to medical management, the need for open biopsy/culture, evolving spinal instability or deformity, and neurologic deficit or deterioration. A thorough knowledge of associated risk factors is required and patients should be stratified for risk preoperatively. The multifaceted approach of risk stratification, early diagnosis and effective treatment, is essential for successful prevention and effective treatment and crucial for a satisfactory outcome.

Outcomes of surgical site infections following spinal column trauma

“…An SSI was associated with developing sepsis in our study. This finding would be expected given that it is a possible complication of SSI in spine surgery for any indication; 15 however, previous studies exploring the association between spine SSI and sepsis are absent in both elective and trauma cohorts. An epidemiological study conducted by Osborn et al .…”

Short-Term Impact of Bracing in Multi-Level Posterior Lumbar Spinal Fusion

“…[31][32][33][34][35] Several studies have indicated bracing in conjunction with antibiotic treatment for SSI; however, this has been directed mainly at patient comfort. 36,37 Further, a recent meta-analysis indicated that the reported rates of SSI following lumbar fusion range from 0.7% to 12%, demonstrating the wide variability in outcomes amongst patient populations. 35 Given that age has been identified as an independent risk-factor for SSI, 38,39 the significant difference in age between the braced and unbraced populations may serve as an alternate explanation of this finding.…”

A Scoring System to Predict the Risk of Surgical Site Infections After Spinal Surgery

“…As already noted, SSIs after spinal surgery lead to increased morbidity, secondary surgical procedures, hospital readmissions, poorer clinical and radiological outcomes, and increased costs. [11][12][13] Many previous clinical studies have reported the prevalence and risk factors of SSIs after spinal surgery. Liu et al, 14 conducted a large-scale single-institution retrospective study including 2715 patients who underwent lumbar fusion surgery, and demonstrated that the prevalence of SSIs was 2.4%.…”