Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Abstract

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal

“…Although IR was curative in our cohort at the latest follow-up, IE offered better maintenance of correction and improved sagittal profile with equivalent reinfection risk and potentially improved overall health-related quality-of-life outcomes. Our study suggests, as have others, that removal involves a risk of deformity progression for which patients may require revision 4,8–11 …”

“…Although several authors have studied infection after spinal arthrodesis, 6,8–14 evidence is limited regarding the superiority of results obtained with spinal implant removal (IR) vs. implant exchange (IE). Several studies suggest that, although IR and short-term antibiotic therapy are curative, patients may experience deformity progression 1,5,8–10 .…”

“…Although several authors have studied infection after spinal arthrodesis, 6,8–14 evidence is limited regarding the superiority of results obtained with spinal implant removal (IR) vs. implant exchange (IE). Several studies suggest that, although IR and short-term antibiotic therapy are curative, patients may experience deformity progression 1,5,8–10 . In the largest study of surgical outcomes of late-developing infection, Muschik et al showed, in a comparative cohort of 45 patients with scoliosis of various causes, that reinstrumentation provided better and more permanent scoliosis correction than IR only 11 …”

Revision Reconstruction of the Cervical Spine in a Patient With Early Deep Surgical Site Infection Complicated by Angular Kyphosis: Case Report and Review

“…Частота развития ИОХВ в вертебрологии колеблется от 2,1 до 16,3%, при этом в общей структуре ИОХВ развитие глубокой периимплантной инфекции как самостоятельной нозологической формы инфекционного осложнения регистрируется с частотой до 20% [8,25]. Согласно временной периодизации V. Prinz и P. Vajkoczy, принято выделять раннюю (ограничена 6 нед.…”

Clinical outcome of postoperative surgical site infections in patients with posterior thoracolumbar and lumbar instrumentation

“…Infections involving spinal instrumentation are associated with greater rates of disability [2][3][4][5]. Recent publications describe the results of implant removal with an increased risk of collapse of the disk space, loss of lordosis, and pseudarthrosis [6,7]. Previous studies have reported that complications following treatment are a burden not only to patients and healthcare professionals but also to the healthcare system [8].…”