Postoperative wound infections complicating adult spine surgery

A review of 19 consecutive patients treated for deep wound infections after spinal surgery was performed. Patients were analyzed for preoperative risk factors, original diagnosis requiring surgery, onset of infection, presentation, treatment, and outcome. These patients (10 men, nine women), with a mean age of 44 years (range 18-74) were treated for 13 deep and six subcutaneous infections: 16 spine infections and nine graft site infections (six with both). All 19 presented with draining wounds on an average of 17 days after surgery (range 4-86). Staphylococcus aureus was cultured in 14. Patients were treated with i.v. antibiotics for an average of 3 weeks (range 0-14) followed by oral antibiotics for an average of 6 weeks (range 2-12). Surgical treatment included an average of 1.8 debridements (range 0-5), primary closure in two, delayed primary closure in seven, and healing by secondary intent in 10. All but three patients were noted to be malnourished at the onset of their infection, with a total lymphocyte count of less than 2,000. Three patients required removal of their hardware. Eighteen of 19 healed or their infections were stabilized, 17 of 18 arthrodeses fused, and no patient had neurological deterioration secondary to the infection. The treatment outlined produced satisfactory results in all but one patient. We conclude that postoperative spine infections are frequently associated with poor nutrition. Although definitive diagnosis is determined by the culture, clinical exam is helpful in establishing a presumptive diagnosis and, thus, earlier institution of surgical and antibiotic treatment.