Postoperative instrumented spine infections: a retrospective review

Postoperative infection following posterior instrumentation of the spine is not uncommon and is a potentially catastrophic complication. Removal of the instrumentation is ideal for eradicating infection. However, removal is not always possible from a structural standpoint. An alternative is to treat the patient with antibiotics in combination with irrigation and debridement.

All patients undergoing posterior instrumentation of the thoracolumbar spine from a single institution between 1996 and 2004 that developed an infection were retrospectively reviewed. The goal of this study was to determine the effectiveness of treating postoperative spinal instrument infections with antibiotics and irrigation and debridement alone without removal of the hardware.

Out of a total of 737 spinal surgeries, 26 cases of postoperative infection were found. Nineteen of the patients had early onset infection, and 7 were late onset. Seventeen (90%) of the 19 patients with early onset infections successfully received long term antibiotics with initial retention of instrumentation. Six out of the 7 patients with late onset infection required removal of instrumentation for cure. All patients were considered cured with at least 36 months follow up with one patient still on oral antibiotics using this approach.

The management of infected spinal instrumentation is dependent on the time of onset. Early onset infections can be successfully treated without instrumentation removal and 4-6 weeks of IV antibiotics followed by a course of oral antibiotics of 4-12 weeks. Late onset infections require instrumentation removal.