Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?

Abstract

<jats:p>As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery.</jats:p> <jats:p>The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4–5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4–5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered.</jats:p> <jats:p>Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable charectaristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.</jats:p>

Total L1 Vertebrectomy With T12-to-L2 Fusion in a Case of Burst Fracture

“…Tissue perfusion may be damaged as a result of surgical trauma, rendering eradication of the microorganisms colonized on the fixators more difficult. 1,12 Some authors have reported that a 6-to 8-week course of specific antibiotics and surgical evacuation of the dead tissues with irrigation usually suffice to bring the infection under control. 1,13 Some have advocated the routine removal of bone grafts and instruments.…”

Bilateral psoas abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) after posterolateral fusion of the lumbar spine

“…Although the incidence of deep spinal infection following surgery is about 0.9% to 1.9% it increases to 3.6% with the use of instrumentation alone, and to 2.4% to 7.5% with instrumentation and graft fusion together. 4,11,12 Upon diagnosing bilateral psoas abscesses, in conjunction with a midline subcutaneous abscess, the decision was made to leave most of the instrumentation in place. The bilateral intertransverse grafts were removed.…”

Anterior Spinal Implant Removal and Associated Complications

“…Muckley et al [21] reported on six cases of psoas abscess as a special complication after spine surgery. Naderi et al [22] reported on a case of a combined epidural and psoas abscess 10 months after posterior instrumentation in a female patient who developed severe back pain after having undergone laparoscopic cholecystectomy 1 month prior to readmission.…”