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Background Previous reports concerning deep surgical site infection (SSI) after posterior spinal instrumentation treated with vacuum-assisted closure (VAC) system indicated that most patients must suffer from a delayed incision suture. To date, there are no published reports about the application of incisional VAC following a one-stage incision suture in the treatment of spinal infections. The purpose of this study was to evaluate the feasibility and efficacy of using an incisional VAC system following a one-stage incision suture combined with continuous irrigation to treat early deep SSI after posterior lumbar fusion with instrumentation. Methods Twenty-one patients who were identified as early deep SSI after posterior lumbar fusion with instrumentation were treated by incisional VAC following a one-stage incision suture combined with continuous irrigation at our spine surgery center between January 2014 and March 2020. Detailed data from medical records were collected and analyzed, including age, gender, primary diagnosis, original operation, number of VAC dressing changes, duration of continuous irrigation, hospital stay, risk factors for infection, bacteria type, and laboratory data. Clinical efficacy was assessed using the pre- and postoperative visual analog scale (VAS) for back pain and Kirkaldy-Willis functional criteria by regular follow-up. Results All the patients were cured and retained implants with an average of 1.9 times of VAC dressing replacement, and an average of 10.2 days of continuous irrigation. There were significant differences between pre-operation and post-operation in ESR, CRP, and VAS score of back pain, respectively (P < 0.05). The satisfactory rate was 90.5% according to Kirkaldy-Willis functional criteria. One patient developed a back skin rash with itching around the wound because of long-time contact with the VAC dressing. There was no recurrent infection or other complications during follow-up. Conclusions Our preliminary results support that the treatment protocol is feasible and effective to treat early deep SSI following posterior lumbar fusion with instrumentation.

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Study Design: Case-control study. Objectives: To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. Methods: 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. Results: The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II ( P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance ( P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups ( P > 0.05). Conclusions: This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.

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