Postoperative Deep Wound Infection in Adults After Posterior Lumbosacral Spine Fusion with Instrumentation: Incidence and Management

Picada, Rogerio; Winter, Robert B.; Lonstein, John E.; Denis, Francis; Pinto, Manuel R.; Smith, Michael D.; Perra, Joseph H.

doi:10.1097/00002517-200002000-00009

Cited by 190 publications

(141 citation statements)

References 9 publications

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“…SSI ranges from 1.9% to 5.5% in most large series [11,13,14,19,22]. MIS has been postulated to reduce SSI rates [10].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lau

Yeo

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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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“…SSI ranges from 1.9% to 5.5% in most large series [11,13,14,19,22]. MIS has been postulated to reduce SSI rates [10].…”

Section: Discussionmentioning

confidence: 99%

“…The rate of SSI in most large series after open spinal surgery ranges from 1.9% to 5.5% depending on a variety of risk factors [11,13,19,22].…”

Section: Introductionmentioning

confidence: 99%

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

Lau

Yeo

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…The flap closure, however, is accompanied with significant morbidity, including extended operative time, blood loss, recurrent infection, dehiscence, flap failure, seroma, donor site morbidity, significant comorbidities and poor tissue characteristics that complicate the wound healing or compromise the chosen flap [18,61,69]. Recently, several authors reported successful management of postoperative infection after spinal instrumentation without flap coverage [12,24,29,33,39,42,51,53,59,61,65,68]. Such a treatment includes repetitive debridements, delayed closure, local irrigation system, antibiotic medication and maintenance of the instrumentation system.…”

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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“…The incidence of deep and superficial wound infection was 6.3 and 1.7%, respectively, whereas somewhat lower or higher incidence of postoperative infections has been noted in patients treated with spinal surgery for reasons other than infection. It was reported that the incidence of infection after spinal instrumentation ranged from 0 to 9.7% [2,5,27,34,[61][62][63]78]. Graft extrusion or hardware failures were observed in 3.8% of all cases.…”

Section: Instrumentationmentioning

confidence: 99%

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

2006

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Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection.

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Postoperative Deep Wound Infection in Adults After Posterior Lumbosacral Spine Fusion with Instrumentation: Incidence and Management

Cited by 190 publications

References 9 publications

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

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

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

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

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