Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery?

Abstract

Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. Questions/purposes (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested casecontrol analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed.Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0-32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3-17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6-7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0-1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. Conclusions In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…The evolution of new minimally invasive approaches, such as Minimally Invasive Surgery (MIS) and Single Incision Laparoscopic Surgery (SILS), allows to perform the surgery by bringing the surgical instruments and endoscope to the surgical site through few or only one small incision, improving the physiological and immuno responses with respect to open surgery [6], and reducing the trauma, without compromising the surgical quality [27,31].…”

Does Spondylodiscitis Follow All Its Parameters? - Report of Three Atypical Cases

“…[28] In this report series, Klebsiella pneumonia infection developed de novo post operative without gastrourinary trauma/associated infection per se thus was worth reporting. The infection rates after MISS the reported rates are 0.09% to 1% [29,30,31] . Concerns regarding the challenges a surgeon faces during initial experience with these systems.…”

“…The longer operative duration and the steep learning curve in MI spinal surgery may amend the infection rates observed at different centres. [30,32] .…”

Arthrodèse lombaire postérieure trans-foraminale mini-invasive chez la personne âgée de plus de 70ans : morbidité, résultats cliniques et radiologiques à 1 an d’une série prospective de 30 cas

“…Le TLIF mini-invasif est une technique dont les résultats à long terme ont déjà été publiés avec des résultats comparables aux TLIF open mais avec une morbidité moindre [17][18][19][20]. Seng [5] retrouve le même taux de fusion et les résultats cliniques dans une étude prospective comparant 40 cas réalisés en mini-invasif versus 40 cas par abord open.…”