Management of early-onset spinal SSI with continuous irrigation and drainage: A retrospective case series

Surgical site infection (SSI) following spinal instrumentation is a severe complication that can compromise surgical outcomes, prolong hospitalization, and increase patient morbidity. Early-onset SSI presents an opportunity for intervention before biofilm maturation. However, there is limited consensus regarding optimal treatment strategies, especially when retaining spinal implants. We conducted a retrospective case series at a single tertiary center, reviewing 4386 spinal procedures performed between January 2013 and October 2022. Thirty-four patients developed early-onset SSI (within 30 days postoperatively). All were treated with debridement, continuous closed irrigation using vancomycin or linezolid solution, and multiple drainage systems, without implant removal. Clinical characteristics, microbiological findings, and changes in laboratory inflammatory markers were analyzed. Paired t-tests were used to assess pre- and post-treatment laboratory differences. The most frequently isolated pathogens were Staphylococcus epidermidis, Staphylococcus aureus, and Staphylococcus haemolyticus, all of which were resistant to penicillin but sensitive to vancomycin and linezolid. Following treatment, significant reductions in white blood cell count, erythrocyte sedimentation rate, and C-reactive protein were observed (P < .05). The mean duration of irrigation was 12.1 ± 2.3 days. No cases required implant removal, and no recurrence or major complications were observed during follow-up. Continuous closed irrigation combined with multiple drainage systems may be a safe and effective method for treating early-onset SSI after spinal surgery while preserving spinal implants. These findings support the potential utility of this approach, although further prospective studies are needed to validate efficacy and address confounding factors.