A Novel Technique for Treating Early Deep Surgical Site Infection After Posterior Lumbar Fusion with Instrumentation

Shi, Hang; Zhu, Lei; Chen, Lu; Jiang, Zan‐Li; Xu, Zheng-Yuan; Wu, Xiao‐Tao

doi:10.1016/j.wneu.2021.09.016

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…The advantages of irrigation include potential reduction in infection rates and removal of exudates and infectious material from the wound bed [ 47 ]. On the contrary, Shi et al demonstrated in a retrospective study of a prospective database that the use of wound VACs combined with CSIS, compared to CSIS alone, in managing early deep SSI after posterior lumbar fusion with instrumentation, resulted in reduced hospital length of stay, duration of antibiotic use, number of dressing changes, and number of debridements [ 48 ]. One group reported success in SSI management after spine surgery with the use of a modified NPWT device that used 3000 mL of saline lavage, which was replaced daily [ 47 ].…”

Section: Npwt In Spinementioning

confidence: 99%

Negative Pressure Wound Therapy in Spinal Surgery

et al. 2022

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Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices. There is nominal but promising prospective evidence on NPWT’s efficacy in select at-risk populations for post-operative wound complications after spinal surgery. As there is currently a paucity of robust clinical evidence on its efficacy, rigorous randomized prospective clinical trials are needed.

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Section: Npwt In Spinementioning

confidence: 99%

Negative Pressure Wound Therapy in Spinal Surgery

et al. 2022

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Section: Introductionmentioning

confidence: 99%

“…Examples include meticulous debridement followed by CSI or negative pressure wound therapy (NPWT) and meticulous debridement followed by antibiotics, bone cement temporary implantation, and other therapies. Despite these treatments, secondary surgery is still often required 5–7 . Therefore, our research team has developed a novel form of treatment for spinal SSI that obviates the need for secondary surgery, namely ultrasound‐guided percutaneous micro‐drainage tube irrigation combined with high negative pressure tube drainage.…”

Section: Introductionmentioning

confidence: 99%

“…There have been many reports of treatment protocols for SSI; however, the efficacy of these treatments is inconsistent and there is still no consensus on the optimal treatment of SSI. 5 , 6 , 7 Surgical debridement combined with antibiotics is generally considered the main means of controlling SSI after spinal surgery. 8 , 9 However, this traditional form of treatment is both traumatic and expensive, has disastrous effects on functional recovery postoperatively, and can result in a variety of complications when multiple debridements are required.…”

Section: Introductionmentioning

confidence: 99%

“…Despite these treatments, secondary surgery is still often required. 5 , 6 , 7 Therefore, our research team has developed a novel form of treatment for spinal SSI that obviates the need for secondary surgery, namely ultrasound‐guided percutaneous micro‐drainage tube irrigation combined with high negative pressure tube drainage. In this retrospective study, we introduce this new treatment modality for deep SSI after spinal surgery and compare its efficacy with that of open debridement.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided percutaneous micro‐drainage tube irrigation combined with high negative pressure tube drainage versus debridement with closed suction irrigation for treating deep surgical site infection after spinal surgery

Cao,

Zeng,

Sun

et al. 2023

International Wound Journal

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It is difficult to avoid deep surgical site infection after spinal surgery. Debridement combined with closed suction irrigation (CSI) and other treatment methods lead to greater trauma and lower satisfaction. We developed a new method for the treatment of SSI, which has the advantages of less invasiveness and lower cost. The cohort of this retrospective study comprised 26 patients with SSI after undergoing spinal surgery in our hospital from August 2017 to March 2022. The patients were divided into CSI and microtube drainage group according to treatment methods. The durations of antibiotic use and hospital stay, hospitalization costs, and functional scores during follow‐up were compared between the two groups. The only baseline characteristic that differed between the two groups was sex. Infection was controlled in both groups and there were no recurrences during follow‐up. However, the length of hospital stay after the first operation and the total length of stay were significantly greater in the CSI group. Hospitalization costs and antibiotic costs were significantly higher in the CSI group. Additionally, the duration of intravenous antibiotic use was significantly longer in the CSI group. Both the CSI and microtube drainage groups had significantly improved of Short Form Health Survey (SF‐36) scores 6 months postoperatively. However, 3 months postoperatively, SF‐36 scores were significantly lower in the CSI group. Compared with debridement followed by CSI, percutaneous micro‐drainage tube irrigation combined with high negative pressure tube drainage is a more efficient and economical means of treating SSI after spinal surgery.

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Incidence and Recurrence of Deep Spine Surgical Site Infections

Freire-Archer

Sarraj

Koziarz

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. To determine a pooled incidence rate for deep surgical site infection (SSI) and compare available evidence for deep SSI management among instrumented spinal fusions. Summary of Background Data. Deep SSI is a common complication of instrumented spinal surgery associated with patient morbidity, poorer long-term outcomes, and higher health care costs. Materials and Methods. We systematically searched Medline and Embase and included studies with an adult patient population undergoing posterior instrumented spinal fusion of the thoracic, lumbar, or sacral spine, with a reported outcome of deep SSI. The primary outcome was the incidence of deep SSI. Secondary outcomes included persistent deep SSI after initial debridement, mean number of debridements, and microbiology. The subsequent meta-analysis combined outcomes for surgical site infection using a random-effects model and quantified heterogeneity using the χ2 test and the I 2 statistic. In addition, a qualitative analysis of management strategies was reported. Results. Of 9087 potentially eligible studies, we included 54 studies (37 comparative and 17 noncomparative). The pooled SSI incidence rate was 1.5% (95% CI, 1.1%–1.9%) based on 209,347 index procedures. Up to 25% of patients (95% CI, 16.8%–35.3%), had a persistent infection. These patients require an average of 1.4 (range: 0.8–1.9) additional debridements. Infecting organisms were commonly gram-positive, and among them, staphylococcus aureus was the most frequent (46%). Qualitative analysis suggests implant retention, especially for early deep SSI management. Evidence was limited for other management strategies. Conclusions. The pooled incidence rate of deep SSI post-thoracolumbar spinal surgery is 1.5%. The rate of recurrence and repeat debridement is at least 12%, up to 25%. Persistent infection is a significant risk, highlighting the need for standardized treatment protocols. Our review further demonstrates heterogeneity in management strategies. Large-scale prospective studies are needed to develop better evidence around deep SSI incidence and management in the instrumented thoracolumbar adult spinal fusion population.

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A Novel Technique for Treating Early Deep Surgical Site Infection After Posterior Lumbar Fusion with Instrumentation

Cited by 3 publications

References 32 publications

Negative Pressure Wound Therapy in Spinal Surgery

Negative Pressure Wound Therapy in Spinal Surgery

Ultrasound‐guided percutaneous micro‐drainage tube irrigation combined with high negative pressure tube drainage versus debridement with closed suction irrigation for treating deep surgical site infection after spinal surgery

Incidence and Recurrence of Deep Spine Surgical Site Infections

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