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Updated: Mar 10, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study
Michael P Glotzbecker1, Jaime A Gomez1, Patricia E Miller1
1Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, HU2, Boston, MA, 02115, USA.
Insights
Early surgical site infections after posterior spinal fusion (PSF) can often be treated without removing implants. Older patients and those with stainless steel implants face higher risks of recurrent infection post-PSF.
Area of Science:
- Spine surgery
- Infectious diseases
- Orthopedic surgery
Background:
- Early surgical site infections (SSI) following posterior spinal fusion (PSF) are not well understood.
- Prompt implant removal after PSF risks pseudarthrosis and deformity progression.
- Understanding infection dynamics is crucial for effective patient management.
Purpose of the Study:
- To identify risk factors for spinal implant failure and acute infection treatment failure after PSF.
- To analyze the natural history of early SSIs post-PSF.
- To determine predictors of recurrent infection.
Main Methods:
- Retrospective review of patients who underwent PSF and developed acute infection within 90 days.
- Analysis of 82 patients from 1999-2011 requiring irrigation and debridement for SSI.
- Univariable and multivariable regression to identify risk factors for infection treatment failure.
Main Results:
- 76% of patients (62/82) were successfully treated without implant removal.
- Older patients (OR=1.3) and those with stainless steel implants (OR=6.4) had higher odds of recurrent infection.
- No significant differences observed in initial presentation time, diagnosis, culture results, or antibiotic duration.
Conclusions:
- Early postoperative SSIs after PSF can be managed effectively with implant retention in most cases.
- Implant exchange is an alternative for managing early SSIs.
- Stainless steel instrumentation and patient age are significant risk factors for late recurrent infections following PSF.
Study Design:
A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection.
Objectives:
The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection.
Background:
The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression.
Methods:
Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment.
Results:
Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12-112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7-32.1; p = .009) and older subjects (OR = 1.3, 95% CI = 1.0-1.6; p = .03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment.
Conclusions:
Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals.
Level Of Evidence:
Level III.
