Postoperative deep surgical-site infection after instrumented spinal surgery: a multicenter study

Area of Science:

• Spine Surgery
• Infectious Diseases
• Orthopedics

Background:

• Deep surgical-site infection (SSI) is a potential complication of instrumented spinal surgery.
• Understanding factors influencing implant salvage is crucial for patient outcomes.

Purpose of the Study:

• To investigate the key factors for implant salvage in patients who developed deep SSI after instrumented spinal surgery.
• To analyze implant retention rates based on the underlying spinal pathology.

Main Methods:

• Retrospective analysis of 3,462 instrumented spinal surgeries from 2004-2008.
• Categorization of 29 patients with deep SSI into three groups: thoracolumbar degenerative disease (DEG), osteoporotic vertebral collapse (OVC), and cervical disorders.
• Comparison of implant retention rates and clinical parameters across the groups.

Main Results:

• Overall deep SSI rate was 1.1% (37 cases).
• Implant retention rates were 40% (DEG), 0% (OVC), and 100% (cervical), with OVC having significantly worse outcomes (p<0.01).
• In the DEG group, retained implants correlated with lower body temperature, white blood cell count, and discharge rate at SSI diagnosis (p<0.05).

Conclusions:

• Initial spinal pathology significantly impacts implant salvage after deep SSI.
• Osteoporotic vertebral collapse presents the highest risk for implant loss.
• Early debridement before drainage may improve implant salvage in the DEG group.