Surgical Site Infection After Posterior Cervical Decompression: The Role of Adiposity-Related Factors

Local subcutaneous fat thickness has been identified as a significant predictor of surgical site infection (SSI) risk in lumbar spine procedures. This study aims to further investigate this association by comparing the impact of body mass index (BMI) and localized fat thickness at the C5 level on SSI risk in patients undergoing posterior cervical decompression without fusion.

A retrospective analysis of patients treated with posterior cervical decompression without fusion or stabilization for cervical spondylotic myelopathy. A combination of univariate and multivariate analyses was employed to identify significant predictors of SSIs.

From the 346 patients, 20 (5.8%) experienced SSIs. Those with SSIs generally had higher BMIs (median 29 ± 4.6 vs. 27 ± 5.2, P = 0.032), greater fat thickness at C5 level (median 27 mm vs. 23 mm, P = 0.012), higher ratio of fat to muscle thickness (median 0.98 vs. 0.75, P = 0.003), and more extensive surgeries (75% had multiple levels operated compared to 55% in the non-SSI cohort, P = 0.001). In multivariable analysis restricted to 1 surgical and 1 patient-related factor, BMI (odds ratio = 1.10, 95% confidence interval 1.01-1.23; P = 0.038) and the number of operated levels (odds ratio = 2.25, 95% confidence interval 1.35-3.74; P = 0.002) remained independent predictors of SSI, whereas fat thickness and fat-to-muscle ratio did not provide additional predictive value beyond BMI.

This study indicates that, localized fat thickness at the C5 level was not shown to be an independent predictive factor for SSI following posterior cervical decompression. Instead, it highlights BMI and the number of operated levels as significant and quantifiable risk factors. Prompt surgical debridement should be considered the first-line treatment for deep or organ space SSIs.