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Updated: Apr 4, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Particular Features of Surgical Site Infection in Posterior Lumbar Interbody Fusion
Jin Hak Kim1, Dong Ki Ahn1, Jin Woo Kim1
1Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
Background:
Previous reports have observed differences only in infection rates between posterolateral fusion and posterior lumbar interbody fusion (PLIF). There have been no reports that describe the particular features of surgical site infection (SSI) in PLIF. In this study, we endeavor to identify the distinguishing characteristics and risk factors of SSI in PLIF.
Methods:
Our study undertook a review of a case series of an institute. Patients who had undergone PLIF consecutively in the author's hospital were reviewed. Two proactive procedures were introduced during the study period. One was irrigation of the autolocal bone, and the other was the intradiscal space irrigation with a nozzle. Infection rate and risk factors were analyzed. For subgroup analysis, the elapsed time to a diagnosis (ETD), clinical manifestations, hematologic findings, and causative bacteria were examined in patients with SSI.
Results:
In a total of 1,831 cases, there were 30 cases of SSI (1.6%). Long operation time was an independent risk factor (p = 0.008), and local bone irrigation was an independent protective factor (p = 0.001). Two cases of referred SSI were included in the subgroup analysis. There were 6/32 (19%) superficial incisional infections (SII), 6/32 (19%) deep incisional infections (DII), and 20/32 (62%) organ/space infections (O/SI). The difference of incidence among three groups was significant (p = 0.002).The most common bacteria encountered were methicillin-resistant Staphylococcus epidermidis followed by methicillin-resistant S. aureus in incisional infections, and no growth followed by S. epidermidis in O/SI. 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).
Conclusions:
The rate of SSI in PLIF was 1.6%, with the most common type being O/SI. The causative bacteria of O/SI was of lower virulence than in the incisional infection, and thus diagnosis was delayed due to its latent and insidious feature. Contamination of auto-local bone was presumed attributable to the progression of SSI. Irrigation of auto-local bone helped in the reduction of SSI.
Insights
Surgical site infections (SSI) in posterior lumbar interbody fusion (PLIF) occurred at 1.6%, with organ/space infections being most common. Local bone irrigation significantly reduced SSI risk.
Area of Science:
- Spine surgery
- Infectious diseases
- Orthopedics
Background:
- Surgical site infection (SSI) features in posterior lumbar interbody fusion (PLIF) remain underexplored.
- Previous research primarily focused on infection rate differences between fusion techniques.
Purpose of the Study:
- To identify distinguishing characteristics of SSI in PLIF.
- To determine risk factors associated with SSI development in PLIF patients.
Main Methods:
- Retrospective review of a consecutive case series of PLIF patients.
- Analysis of infection rates, risk factors, and clinical presentations.
- Evaluation of proactive measures: autologous bone irrigation and intradiscal space irrigation.
Main Results:
- Overall SSI rate was 1.6% (30/1831 cases).
- Long operation time was a significant risk factor; local bone irrigation was a protective factor.
- Organ/space infections (O/SI) were the most frequent type (62%), with delayed diagnosis.
Conclusions:
- SSI in PLIF occurs at a 1.6% rate, predominantly as O/SI.
- O/SI exhibits lower bacterial virulence, leading to delayed diagnosis.
- Autologous bone contamination is a suspected progression factor; bone irrigation effectively reduces SSI incidence.
