Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases

Muschik, M.; Lück, Wiebke; Schlenzka, Dietrich

doi:10.1007/s00586-004-0694-4

Cited by 114 publications

(74 citation statements)

References 12 publications

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“…One-or two-stage re-instrumentation seems reasonable protocol as it is for an infected joint replacement. 20 This treatment pathway has been used previously for late infection in patients with deformity with less loss of correction. 21 However, there is always the risk of recurrent infection: two of our four re-instrumented patients had a recurrent SSI, despite appropriate combined antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Implant survival after deep infection of an instrumented spinal fusion

Núñez-Pereira

Pellisé

Rodríguez-Pardo

et al. 2013

The Bone & Joint Journal

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Section: Discussionmentioning

confidence: 99%

Implant survival after deep infection of an instrumented spinal fusion

Núñez-Pereira

Pellisé

Rodríguez-Pardo

et al. 2013

The Bone & Joint Journal

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“…Others, on the other hand, prefer removal of the instruments to eradicate the infection that followed the instrumented spinal fusion [1,4,13,55,56,62]. Another possibility is instrumentation removal in case of late deep infection, debridement and new reinstrumentation to achieve permanent correction for scoliosis [50]. These are well known options for implants with infections either by complete removal or one (implant change) or two stage (removal and delayed reimplantation) procedures [6,26,28,71].…”

Section: Discussionmentioning

confidence: 99%

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

et al. 2006

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The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.

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“…Some authors recommend implant removal to all patients once fusion is achieved [1,2], but this surgical procedure has some potential complications like progressive loss of correction [23] or vertebral body compression fractures [28]. The economic cost of removing implants to all patients with posterior spinal instrumentations is also quite considerable.…”

Section: Discussionmentioning

confidence: 99%

Metal levels in corrosion of spinal implants

Rı́o¹,

Beguiristáin²,

Duart³

2007

Eur Spine J

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Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants.

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Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases

Cited by 114 publications

References 12 publications

Implant survival after deep infection of an instrumented spinal fusion

Implant survival after deep infection of an instrumented spinal fusion

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

Metal levels in corrosion of spinal implants

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