Infections in spinal instrumentation

Abstract

Surgical-site infection (SSI ) in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment and estimated blood loss are well established in the literature to affect the risk of infection. Infection after spine surgery with instrumentation is becoming a common pathology. The reported infection rates range from 0.7% to 11.9%, depending on the diagnosis and complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. These infections after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. Because the medical, economic and social costs of SSI after spinal instrumentation are enormous, any significant reduction in risks will pay dividends. The goal of this literature review was to analyse risk factors, causative organisms, diagnostic elements (both clinical and biological), different treatment options and their efficiency and consequences and the means of SSI prevention.

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

“…Patients with infections have worse pain-related outcomes, increased deformity, higher medical costs, and longer hospital stays. 3,6,19,39 We found an overall reported infection rate of 4.3% over a mean follow-up period of 34.8 months in this review of studies in which the Dynesys dynamic stabilization system was used. This is similar to the reported literature on infection rates for lumbar fusion, which range from 1% to 5%.…”

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.…”

Variables associated with remission in spinal surgical site infections

“…To cite examples, Clark and Shufflebarger treated delayed infections with surgery and 48-72 hours of parenteral antibiotics followed by ten days of targeted oral antibiotics. All infections were eradicated (16,30). Likewise, Richards and Emara administered antimicrobials only for three weeks, of which 2-5 days intravenously, followed by a 7 to 14 day-course of oral treatment (16,31).…”

“…All infections were eradicated (16,30). Likewise, Richards and Emara administered antimicrobials only for three weeks, of which 2-5 days intravenously, followed by a 7 to 14 day-course of oral treatment (16,31). Of note, these cited examples concern mostly paediatric and immunecompetent adolescent patients, but confirm the feasibility of shorter regimens for these specific patient populations.…”

“…Any benefits of long-term antibiotic use remain to be determined (3). Other recent options and recommendations include hyperbaric oxygen, negative-pressure vacuum wound therapy (13)(14)(15), closed suction irrigation systems (2,16), or local antibiotic use (17). However, comparative data supporting these individual recommendations are lacking.…”