Two-Year Outcomes of Postoperative Spine Infection: Implant Retention and Predictors of Treatment Failure

Postoperative spine infection (PSI) after surgery occurs in approximately 1%-2% of cases and is associated with significant morbidity. High-quality evidence to guide optimal prevention and management of PSI is limited.

We retrospectively identified all adult patients over a 3-year period (2020-2023) who required reoperation for deep PSI. Clinical, microbiological therapy, and 24-month outcome data were collected. Treatment failure was defined as unplanned return to the operating room secondary to persistent infection or infection-related implant failure requiring removal. Descriptive statistics and univariate logistic regression were used to identify factors associated with failure.

Sixty-three deep PSI cases were identified (range 18-91 years, median 59 years, 56% female). Onset of infection ranged from 4 days to 30 weeks postoperatively (median 20 days). Staphylococcus aureus and Enterobacterales were the most common pathogens, followed by coagulase-negative staphylococci and Cutibacterium acnes. Treatment failure occurred in 13 cases (21%). In cases where implants were present (81% of total cohort), planned antibiotic durations of either 12 weeks or 24 weeks demonstrated similar success rates (P = .76). Infections involving Cutibacterium acnes were more likely associated with implant removal (P = .04). No other significant risk factors for failure were identified.

Most PSIs were effectively managed in this cohort with surgical debridement and targeted antibiotics, allowing implant retention in most patients with instrumentation.