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Updated: Jul 24, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases
Study Design:
A retrospective analysis of eight cases of delayed spinal infection after elective posterior or combined anterior and posterior spinal instrumentation and fusion.
Objectives:
These cases are reviewed to identify risk factors for delayed spinal infection after elective instrumentation and to describe the treatment of this complication.
Summary Of Background Data:
Delayed spinal infection after elective spinal instrumentation and fusion is uncommon. This diagnosis is frequently difficult.
Methods:
Five cases seen in the senior author's practice and three referral cases are reviewed.
Results:
Of these eight cases, the organisms were Staphylococcus epidermidis in six cases, Propionibacterium acnes in one cases, and in the final patient, all intraoperative cultures were negative. Clinical presentations were variable; however, all patients reported back pain. Seven patients had elevated erythrocyte sedimentation rates, averaging 57 mm/hour. Only two had elevated white blood cell counts. No distant foci of infection were identified in any patient. Five-patients were found to have at least one pseudarthrosis. All patients were treated with debridement, instrumentation removal, and primary wound closure over drains followed by a minimum 6-week course of culture-directed postoperative antibiotics. At an average follow-up of 18 months, no patient has evidence of infection.
Conclusions:
The diagnosis of delayed infection after elective spinal instrumentation and fusion requires a high index of suspicion. These infections may have been caused by intraoperative inoculation. All patients were successfully treated with debridement, instrumentation removal, and culture-directed postoperative antibiotics.
Insights
Delayed spinal infection following elective spinal instrumentation is rare but challenging to diagnose. Prompt surgical debridement, hardware removal, and antibiotics effectively treat these post-operative infections.
Area of Science:
- Spinal surgery
- Infectious diseases
- Orthopedic surgery
Background:
- Delayed spinal infection after elective spinal instrumentation and fusion is an uncommon yet difficult diagnosis.
- Identifying risk factors and effective treatment strategies for this complication is crucial.
Observation:
- A retrospective analysis of eight cases of delayed spinal infection post-elective spinal instrumentation was conducted.
- Common pathogens included Staphylococcus epidermidis and Propionibacterium acnes; some cases had negative cultures.
- Patients presented with variable symptoms, primarily back pain, and elevated erythrocyte sedimentation rates.
Findings:
- Five patients had associated pseudarthrosis, suggesting a link between non-union and infection.
- Treatment involved debridement, instrumentation removal, and a minimum 6-week course of culture-directed antibiotics.
- All eight patients achieved successful outcomes with no evidence of recurrent infection at 18-month follow-up.
Implications:
- A high index of suspicion is necessary for diagnosing delayed spinal infections.
- Intraoperative bacterial inoculation is a potential cause.
- Multimodal treatment including surgical intervention and antibiotics offers a successful management pathway.
