Treatment of Surgical Site Infection in Posterior Lumbar Interbody Fusion

Abstract

Study DesignA retrospective observational and case control study.PurposeTo identify appropriate treatment options according to the types of surgical site infections (SSI) in instrumented posterior lumbar interbody fusion (PLIF).Overview of LiteratureThere has been no agreement or consensus with regard to this matter.MethodsThirty-two consecutive SSIs were included and followed for more than one year. The elapsed time to diagnosis (ETD) according to the type of SSI was analyzed. The treatment options for each type and consequent clinical results were reviewed. The risk factors of removing the implants were analyzed.ResultsThere were 6/32 (19%) superficial incisional, 6/32 (19%) deep incisional, and 20/32 (62%) organ/space infection cases (SII, DII, and O/SI, respectively) (p=0.002). ETD was 8.5±2.3 days in SII, 8.7±2.3 days in DII, and 164.5±131.1 days in O/SI (p=0.013). All cases of SII and DII retained implants and were treated by repeated irrigation and secondary closure. Among O/SIs, 10/20 were treated conservatively. Nine out of ten underwent posterior one stage simultaneous revision (POSSR) and in one case, the cage was removed anteriorly. Those who had ETDs longer than 3 months showed a significant risk of implant removal (p=0.008, odds ratio [OR]=40.3). The Oswestry disability index (ODI) improved from 47.3% to 33.8% in SII, from 55.0% to 32.3% in DII, and from 53.4% to 42.1% in O/SI (p=0.002). There was no difference among the three groups (p=0.106); however, there was a partial correlation between ETD and final ODI (r=0.382, p=0.034).ConclusionsLatent O/SI was the most common type of SSI in PLIF. In cases of SII and DII, early aggressive wound management and secondary closure was effective and implant removal was not necessary. In some cases of O/SI, implant removal was unavoidable. However, implant removal could be averted by an earlier diagnosis. POSSR was feasible and safe. Functional outcomes were improved; however, disability increased as ETD increased.

Adjacent Segment Infection after Lumbar Fusion: A Case Report and the Literature Review

“…The type and duration of antibiotic therapy varied in the literatures. However, antibiotic administration over 6 weeks intravenously and 3 months orally was recommended in most reports [8,9]. Even after surgical debridement and instrumentation removal, 4-6 weeks of intravenous antibiotic therapy and several weeks of oral therapy were necessary and reported to result in lower recurrence rate [10,11].…”

Is Closed-Suction Drainage Essential after Minimally Invasive Lumbar Fusion Surgery?: A Retrospective Review of 381 Cases

“…We included patients with a minimal follow-up of 12 months so as to include most of the patients encountering infection after lumbar fusion surgery 18) . It was critical to note that in our study there were 27% patients with diabetes mellitus and 36% patients with hypertension.…”

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

“…Most of the studies reported have encountered infections within first 12 months of surgery except some isolated reports in scoliosis surgery [2425]. Hence, it is necessary to have an adequate follow-up postsurgery to validate the observed infection rates.…”

“…The dead space created due to index surgery and the soft tissues exposed to infection are much less and adequate coverage can be obtained even with thorough debridement alleviating the need for secondary coverage procedures. Implant removal can be averted in cases of acute infections except late onset infections and Propionibacterium acnes [1610122530]. A robust clinical surveillance and prompt recognition of clinical infection plays a major role in successful outcomes after SSIs.…”