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New Definition for Postoperative Spine Infection (PSI): From the Workgroup of the Musculoskeletal Infection Society
Jeremy D Shaw1,2, Sandra B Nelson3, Claus Simpfendorfer4
1Intermountain Health, Intermountain Neurosciences.
Study Design:
Modified Delphi consensus process.
Objective:
To establish a standardized, consensus-driven definition for postoperative spine infection (PSI) for research, diagnosis, and management.
Summary Of Background Data:
Postoperative infection is a devastating and common complication following spine surgery. Rates of PSI in the literature range from 0% to over 20% depending on surgical indication and invasiveness. Despite the implications of PSI, there is no universally accepted diagnostic standard or consensus definition for infection following spine surgery, hindering research and treatment of this challenging clinical condition.
Methods:
A multispecialty workgroup convened by the Musculoskeletal Infection Society (MSIS) conducted a systematic literature review. Using data from the systematic review, an expert panel completed a modified Delphi process to achieve consensus. The panel included nine fellowship-trained, board-certified physicians with expertise in infectious diseases, orthopaedic and neurologic spine surgery, and musculoskeletal radiology. Iterative rounds focused on criterion selection, importance ranking, categorical grouping, and final constellation development for PSI diagnosis. Consensus was defined as a 2/3 majority, with a target of 100%.
Results:
The workgroup achieved 100% consensus on a new PSI definition, which incorporates six clinical domains: wound features, microbiology, imaging, inflammatory biomarkers, intraoperative findings, and histology. A single microbiological stand-alone criterion-identification of a phenotypically indistinguishable organism from two or more deep operative site specimens-was established as pathognomonic for postoperative spine infection. Additional primary and secondary supporting criteria were defined, with specific combinations required to classify cases as definite or probable PSI. Final definitions were ratified by the boards of MSIS and the European Bone & Joint Infection Society (EBJIS).
Conclusion:
This consensus-based definition provides a standardized framework for diagnosing postoperative spine infection, facilitating research and clinical management. The criteria balance sensitivity and specificity across diverse clinical scenarios and represent the first multispecialty, society-endorsed definition for PSI.
Insights
A new definition for postoperative spine infection (PSI) was established using a modified Delphi process. This standardized framework aids research and diagnosis of this common complication following spine surgery.
Area of Science:
- Spine Surgery
- Infectious Diseases
- Medical Diagnostics
Background:
- Postoperative spine infection (PSI) is a frequent and severe complication of spine surgery.
- Existing literature shows wide-ranging PSI rates (0-20%) due to varied diagnostic criteria.
- Lack of a standardized definition hinders effective research and clinical management of PSI.
Purpose of the Study:
- To develop a standardized, consensus-driven definition for postoperative spine infection (PSI).
- To facilitate consistent research, diagnosis, and management of PSI.
- To address the need for a universally accepted diagnostic standard in spine surgery.
Main Methods:
- A multispecialty workgroup utilized a systematic literature review.
- An expert panel applied a modified Delphi consensus process with iterative rounds.
- Consensus required a 2/3 majority, aiming for 100% agreement.
Main Results:
- Achieved 100% consensus on a novel PSI definition incorporating six clinical domains.
- Established a pathognomonic microbiological criterion for definitive PSI diagnosis.
- Defined primary and secondary criteria for classifying definite or probable PSI cases.
Conclusions:
- The new consensus definition offers a standardized approach to diagnosing PSI.
- This framework improves research consistency and clinical management of spine infections.
- Represents the first multispecialty, society-endorsed definition for PSI.
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