Progress in diagnosis and treatment of cervical postoperative infection

Abstract

Postoperative infection is the commonest complication that causes failure of spinal surgery. Although the rate of infection after cervical surgery is lower than that after lumbar surgery, the absolute number of cases is increasing. In recent years, new techniques, such as serum amyloid A and fludeoxyglucose ( 18 F) positron emission tomography (18F-FDG PET), have emerged and gradually been employed in the diagnosis of postoperative infection, updating the ability to identify the presence of infection. Most patients with cervical postoperative infection require re-operation. There are three principles for such surgery: thorough debridement, adequate drainage and ensuring stability of the spine. Some severe cases even need emergency surgery. This article aims to discuss the controversial issues in diagnosis and treatment of cervical postoperative infection, as well as progress in related studies.Key words: Cervical vertebrae; Diagnosis; Infection; Surgical procedures, operative; Therapy Cervical postoperative infections occur after cervical spine surgery and other invasive operations. The incidence of cervical postoperative infection is lower than that of postoperative infection of other parts of the spine. However, in recent years with the increasing amount of cervical spine surgery and the launching of new treatment, the absolute number of cases has increased, which has drawn more clinical attention to this issue.It has been reported that the infection rate after anterior cervical surgery is in the 0-1% range 1,2 , and that posterior cervical surgery operation has a relatively higher risk of infection, about 1% with simple decompression and 4.5-9% with internal fixation 3,4 . Classificationo s4_140 152..157Cervical postoperative infection is classified as superficial or deep according to the level of infection 5 . Superficial infection is limited to the skin and subcutaneous layers, and does not involve the deep fascia. Deep infection refers to the infection in the deep fascia (nuchal ligament and platysma muscle) and involves muscle and its underlying compartments. Deep infection includes intervertebral disc inflammation (also called intervertebral space infection), vertebral osteomyelitis and epidural abscess. Cervical postoperative infection can also be classified according to its time of occurrence as early (within 3 weeks of the operation) and late-onset infection (more than 4 weeks after surgery).

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

“…Although the previously described infection rates of 4.5%-9% 8,34 have remained relatively constant, the increasing frequency of dorsal cervical surgeries has resulted in a greater absolute number of infections after spinal surgery. 7 The present study was performed to define the impact that infections have on patients undergoing DCF surgery from a QOL and financial perspective. We hypothesized that a deep wound infection following DCF would increase both direct and indirect costs while decreasing patient QOL.…”

“…2,15 The dorsal surgical approach to the cervical spine has a 4.5%-9% postoperative infection rate compared with a 0%-1% rate associated with a ventral approach. 3,7,17,21 Whereas preoperative risk factors for postoperative cervical infections (including smoking, diabetes, and intraoperative blood loss) have been investigated, few studies have assessed the quality of life (QOL) and hospital costs associated with these infections. 24,33 Quantifying cost and QOL parameters will help assess the utility of prophylactic and postoperative management strategies for postoperative wound infections.…”

Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

“…Although MRI remains the imaging of choice, many limitations hamper its role in the diagnosis of SSI. Diagnostic findings depend on many technical parameters, and artifacts from implants may hinder the interpretation of results ( 76 , 77 ). In addition, some degenerative or inflammatory non-infectious diseases may simulate spinal infection leading to a false positive result ( 75 , 76 ).…”

“…Many studies have been recently undertaken to define the imaging technique that will resolve the above-mentioned controversies and limitations surrounding the radiological diagnosis of SSI following spine surgery. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is one modality that has lately shown utility in patients with suspected SSI ( 76 ). In a prospective cohort study that assessed over 300 patients, Ohtori et al found that a definitive diagnosis of SSI was achieved more often when 18FDG-PET was utilized ( 78 ).…”

Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults

“…All papers, both original studies [102,106,108] and reviews [37,78,79,165,167,168], included for the evaluation of this statement agree that [ 18 F]FDG-PET/CT is an accurate imaging technique for post-surgical spine infection diagnosis with or without hardware. Even though the number of patients studied is still limited, evidence-based data indicate that [ 18 F]FDG-PET/CT has better diagnostic accuracy than other diagnostic modalities.…”