[Infections after reconstructive spinal interventions : How do I deal with them?]

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Neurosurgery

Background:

• Postoperative spinal surgical site infections (SSIs) affect up to 20% of patients, leading to severe complications and high treatment costs.
• Common pathogens originate from skin or fecal flora, with risk factors including obesity, diabetes, high ASA scores, and intraoperative events like blood loss or dural tears.
• Prophylaxis through pre- and postoperative risk minimization is essential.

Purpose of the Study:

• To review current literature on perioperative and postoperative spinal infections.
• To provide an overview of diagnostic and therapeutic strategies for spinal SSIs.

Main Methods:

• Literature review of current data on spinal surgical site infections.
• Analysis of risk factors, bacterial origins, and treatment modalities.

Main Results:

• Early infections may allow instrumentation retention after debridement, lavage, and culturing.
• Late-onset infections, particularly with biofilms or loosening, often necessitate instrumentation removal and potential replacement.
• Negative pressure wound therapy can be an effective adjuvant treatment.

Conclusions:

• Effective management of spinal SSIs requires a multi-faceted approach, including risk factor control, prompt diagnosis, and tailored surgical strategies.
• Early operative revision and microbiological sampling are key for successful treatment.
• Adjuvant therapies and careful consideration of instrumentation in late-onset infections are vital for optimizing patient recovery.