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Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management
E Benavent1, X Kortajarena2, B Sobrino-Diaz3
1Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain.
Background:
Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR).
Aim:
To identify pVOM risk factors and evaluate management strategies.
Methods:
From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors.
Findings:
Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR): 1.10; 95% confidence interval (CI): 1.03-1.18), interbody fusion (aOR: 6.96; 95% CI: 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83; 95% CI: 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067).
Conclusion:
Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.
Insights
Vertebral osteomyelitis after spine surgery is linked to older age, interbody fusion, and CoNS infections. Management should consider the timing of infection and spinal fusion status for better outcomes.
Area of Science:
- Spine Surgery
- Infectious Diseases
- Orthopedics
Background:
- Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare but serious complication.
- Early infections (<60 days) often involve superficial tissues and may be managed with debridement, antibiotics, and implant retention (DAIR).
Purpose of the Study:
- To identify independent risk factors for pVOM.
- To evaluate the effectiveness of different management strategies for pVOM.
Main Methods:
- A multicentre cohort study of deep infections after spine instrumentation (IASI) from 2010-2016.
- Comparison of pVOM cases with non-vertebral deep infections.
- Multivariate analysis to determine risk factors for pVOM.
Main Results:
- Among 410 IASI cases, 19 (4.6%) had pVOM, with a higher incidence in late infections (>60 days).
- Independent risk factors for pVOM included older age (aOR: 1.10), interbody fusion (aOR: 6.96), and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83).
- pVOM cases had a significantly worse prognosis (26.3% failure rate) compared to non-vertebral infections (10.8%).
Conclusions:
- Older age, interbody fusion devices, and CoNS etiology are significant risk factors for pVOM.
- While pVOM portends a worse prognosis, surgical material removal should be reserved for late-stage infections or cases with achieved spinal fusion.
- Management strategies, including implant retention versus removal, require careful consideration based on infection timing and fusion status.
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