Use of negative pressure wound therapy in patients with early deep implant-associated spine infection

Abstract

BACKGROUND: Implantable metal fixators are widely used in modern spine surgery for surgical treatment of a wide spectrum of pathologies: degenerative pathology, neoplasms, spinal deformities, traumas. The increasing number of operations entails an increase in the number of complications, including implant-associated infection (IAI). The rate of IAI, according to the literature, accounts for up to 20% of cases. The treatment of such complications represents a significant burden on the healthcare system, since patients require multiple revision interventions, antibacterial therapy and other treatment measures requiring a comprehensive interdisciplinary approach. A single, generally accepted algorithm for treatment of deep spinal IAI has not yet been developed, but the use of negative pressure treatment systems (vacuum therapy) is becoming increasingly widespread. Despite the good results of the method reflected in the literature, the evidence base for treating deep IAI remains limited. AIM: To evaluate the results of negative pressure wound therapy (NPWT) treatment of early deep implant-associated spine infection. MATERIALS AND METHODS: An observational retrospective study included 28patients with early deep implant-associated spine infection treated with surgical debridement combined with NPWT method in 2019–2023, among them 16 (57.1%) female and 12 (42.9%) male. Obtained data are presented as mean and standard deviation. Comparison of laboratory blood parameters at different time points was made using Wilcoxon W-test. Differences were considered significant at p0.05. RESULTS: In all patients, the remission of infection was achieved. The fixator was retained in 18 (64.3% of total) cases, partially removed in 1case (3.6%), completely removed in 8cases (28.6%), and replaced in 1case (3.6%). On average 5.7±2.83 NPWT dressings were required to achieve the clinical cure. In 27cases (96.4% of total) the wound was closed with the help of secondary sutures, in 1case (3.6%) plastic surgery was provided. The average duration of antibiotic therapy was 38.2±18.1days, the number of hospital days was 42.1±23.31. Relapse was noted in 1 (3.6%) patient with preserved metal structure one month after discharge. During microbiological tests, positive results (growth of microflora) were recorded in 26 (92.9% of total) patients, negative – in 2casеs (7.1%). Among these, in 19 (67.9%) cases, a change of leading pathogen occurred during treatment period. CONCLUSION: NPWT is an effective and safe method that can be characterized by good clinical results.