Infections associated with spinal implants

Abstract

Spinal infections represent a difficult challenge to treating clinicians. Infections in the presence of implants are even more so. In this review the literature appears to reflect a change of practice in which the aim is to retain implants if possible. The newer spinal procedures such as disc replacements pose different problems largely due to the more difficult access. The situation in the spine is more difficult than in general orthopaedics when dealing with infection due to the requirement for stability and to protect neurological function. The main thrust of management, therefore, is early diagnosis and a high index of suspicion followed by adequate if not radical management in a multidisciplinary setting. In the event prevention is better than cure and therefore consideration of the various mechanisms to avoid infection must be taken. There are some 'novel' considerations for the avoidance of infection alongside the tried and tested techniques. There are also new procedures for wound closure and the elimination of dead space.

Multiple recurrent postoperative spinal infections due to an unrecognized presacral abscess following placement of bicortical sacral screws: case report

“…Early and aggressive handling of the infected soft tissues typically allows the patient to retain the hardware. 2,3,6,8,14,19 There have been no reports of multiple recurrences from a presacral source.…”

“…17,19 Although the literature is not unanimous, several studies cite the benefit of retaining spinal implants in the treatment of acute SSI. Quaile states that the aim is to retain implants if possible, 19 and Levi et al advocate leaving hardware in place whenever feasible, so long as it is securely attached to the spine. In a retrospective study, hardware was maintained in 16 of 17 successfully treated SSIs.…”

“…2,6,9 Although instrumentation does markedly increase the risk of infection, it is often necessary when the patient's spine requires stabilization. 1,14,19,20 Bicortical screws are a good example of this: by breaching 2 segments of cortical bone, these screws offer a greater degree of stability than do monocortical screws. 5,13,21 This is especially important at the lumbosacral junction when a long fusion lever arm is present.…”

“…14,15,19 Longer operating times and prolonged retraction associated with the placement of instrumentation probably contribute. 17,19 Although the literature is not unanimous, several studies cite the benefit of retaining spinal implants in the treatment of acute SSI. Quaile states that the aim is to retain implants if possible, 19 and Levi et al advocate leaving hardware in place whenever feasible, so long as it is securely attached to the spine.…”

“…3,4,7,8,10,12,14,15,19 Additionally, the presence of instrumentation can make infections more difficult to treat. 14,15,19 Longer operating times and prolonged retraction associated with the placement of instrumentation probably contribute. 17,19 Although the literature is not unanimous, several studies cite the benefit of retaining spinal implants in the treatment of acute SSI.…”