Surgical infections in the traumatized spine

Patients with acute spinal injury who require operative intervention may be at increased risk for postoperative surgical-site infection when compared with patients having elective spinal surgery. Various local, systemic, and iatrogenic factors predispose this unique population of patients to post-surgical infection. Nonmodifiable risk factors for surgical-site infection in spine trauma include age, medical comorbidities, and neurologic status. Modifiable risk factors include poor postoperative nutritional status, delay from time of injury to surgical intervention, posterior surgical approach, higher number of levels stabilized, length of postoperative stay in the intensive care unit, and treatment by a single specialty team (versus treatment by successive orthopaedic and neurosurgical teams). When treating patients with spine trauma, a high index of suspicion should be maintained for patients with multiple risk factors for infection and every effort should be made to minimize the modifiable risk factors.

Level V (expert opinion). Please see the Guidelines for Authors for a complete description of levels of evidence.