Related Experiment Video
Updated: Aug 6, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Postoperative spinal ımplant ınfection defined using a standardized MSIS-EBJIS spine-specific diagnostic framework:
Ali Kutta Çelik1, Mustafa Uğuz2, Fatih Erdem2
1Department of Infectious Diseases and Clinical Microbiology, Mersin Training and Research Hospital, Mersin, Türkiye. drakcelik27@yahoo.com.tr.
Background:
Postoperative spinal implant infection (PSII) is a clinically significant complication following spinal instrumentation, with diagnostic challenges related to biofilm formation and the lack of standardized criteria. This study aimed to investigate clinical, laboratory, and perioperative factors associated with PSII using a standardized spine-specific diagnostic framework proposed by the Musculoskeletal Infection Society (MSIS) European Bone and Joint Infection Society (EBJIS) workgroup.
Methods:
In this retrospective cohort study, 224 adult patients who underwent posterior spinal instrumentation surgery between January 2025 and January 2026 were included. Demographic characteristics, comorbidities, laboratory parameters, perioperative variables, and microbiological findings were obtained from electronic medical records. PSII was defined using a standardized spine-specific diagnostic framework proposed by the MSIS-EBJIS workgroup, integrating clinical, microbiological, and histopathological criteria. Variables with p < 0.10 in univariate analysis and strong clinical plausibility were considered for multivariate logistic regression.
Results:
PSII developed in 18 patients (8.0%). No significant association was found between PSII and demographic variables or comorbidities. Elevated C-reactive protein (CRP) levels and lower serum albumin levels were associated with PSII (p < 0.05). In univariate analysis, American Society of Anesthesiologists (ASA) score ≥ 3, emergency surgery, perioperative steroid use, low molecular weight heparin use, postoperative prone recovery positioning, and intensive care unit admission were significantly associated with PSII. In multivariate analysis, only emergency surgery remained independently associated with PSII (OR: 6.48; 95% CI: 1.28-32.70; p = 0.024).
Conclusions:
PSII remains a clinically important complication following spinal instrumentation surgery. In this study, emergency surgery was the only variable independently associated with PSII; however, this finding should be interpreted cautiously given the limited number of events and wide confidence intervals. Elevated CRP levels and hypoalbuminemia were identified as associated findings rather than independent predictors. The use of structured spine-specific diagnostic frameworks based on the MSIS-EBJIS workgroup definition may improve consistency in PSII classification and enhance comparability across future studies. Larger prospective studies are needed to further clarify independent predictors and optimize preventive strategies. Emergency spinal instrumentation procedures may represent higher-risk clinical settings for PSII and may warrant enhanced perioperative infection prevention strategies and closer postoperative surveillance.
Insights
Emergency surgery is the primary risk factor for postoperative spinal implant infection (PSII) following spinal instrumentation. Further research is needed to identify other predictors and optimize prevention strategies for these infections.
Area of Science:
- Spinal surgery
- Infectious disease
- Orthopedics
Background:
- Postoperative spinal implant infection (PSII) is a significant complication of spinal instrumentation.
- Diagnostic challenges exist due to biofilm formation and lack of standardized criteria.
- This study utilized a standardized diagnostic framework from the Musculoskeletal Infection Society (MSIS) and European Bone and Joint Infection Society (EBJIS) workgroup.
Purpose of the Study:
- To investigate clinical, laboratory, and perioperative factors associated with PSII.
- To apply a standardized spine-specific diagnostic framework for PSII classification.
- To identify potential risk factors for PSII in patients undergoing spinal instrumentation.
Main Methods:
- Retrospective cohort study of 224 adult patients undergoing posterior spinal instrumentation.
- Data collected included demographics, comorbidities, laboratory parameters, and perioperative variables.
- PSII defined using the MSIS-EBJIS standardized framework; logistic regression used for analysis.
Main Results:
- PSII occurred in 8.0% of patients (18/224).
- Elevated C-reactive protein (CRP) and hypoalbuminemia were associated with PSII.
- Emergency surgery was the only independent predictor of PSII (OR: 6.48; p=0.024).
Conclusions:
- Emergency surgery is independently associated with PSII, though findings require cautious interpretation.
- CRP and hypoalbuminemia are associated findings, not independent predictors.
- Standardized diagnostic frameworks improve PSII classification; larger studies are needed for prevention strategies.
