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Published on: December 3, 2017
State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections
Don Bambino Geno Tai1, Robin Patel2,3, Francis Lovecchio4
1Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract:
Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed.
Insights
Spinal implant infections after surgery require careful management. Current treatments involve antibiotics and sometimes surgery, but more research is needed for better diagnostics and therapies.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Imaging
Background:
- Spinal implant infections are severe complications of spinal fusion surgeries.
- These infections lead to high morbidity and complex treatment challenges.
- Early symptoms include wound problems, pain, and fever; chronic cases may cause implant failure.
Purpose of the Study:
- To review current diagnostic and treatment strategies for spinal implant infections.
- To highlight the limitations of existing approaches and the need for further research.
Main Methods:
- Review of current literature on spinal implant infections.
- Discussion of diagnostic imaging, particularly Magnetic Resonance Imaging (MRI) and its limitations due to metal artifacts.
- Analysis of treatment options including surgical debridement, implant retention/removal, and antibiotic therapy.
Main Results:
- Early infections present with localized signs; chronic infections may manifest as implant failure.
- MRI is preferred for diagnosis but affected by artifacts.
- Standard treatment involves debridement with implant retention and prolonged antibiotics (≥12 weeks), especially for Staphylococcal infections.
- Suppressive antibiotics or implant revision are options for complex or delayed cases.
Conclusions:
- Current management guidelines are largely extrapolated from periprosthetic joint infection literature.
- There is a significant need for more research to optimize diagnostic and treatment protocols specifically for spinal implant infections.
