TREATMENT OF SURGICAL SITE INFECTIONS FOLLOWING POSTERIOR SPINAL FUSION AND INSTRUMENTATION WITH DEBRIDEMENT AND PRIMARY CLOSURE WITHOUT IMPLANT REMOVAL

Abstract

To describe the success rate of surgical debridement and primary closure without implant removal in the treatment of postoperative spinal wound infections with instrumentation.

One thousand four hundred fifty two posterior instrumented fusions were performed between 2000 and 2006. A retrospective record review identified 63 cases with acute (< 6 weeks) postoperative infection (4.6%). The preoperative diagnosis included fracture (24), adolescent idiopathic scoliosis (4), stenosis/degenerative spondylolisthesis (24), adult deformity (4), neuromuscular scoliosis (3), tumor (2), cervical myelopathy (2). All patients were treated with irrigation – debridement and closed suction drainage placement. Cultures were obtained, all wounds closed primarily and appropriate intravenous antibiotic treatments were initiated. The treatment protocol dictated the appropriate time to discontinue drains and antibiotics. The follow-up period ranged from 6 to 24 months.

The majority of infections occurred during the early postoperative period (less than 2 weeks). Fifty-six (89%) resolved without recurrence with only one surgical debridement. Seven patients (11%) required a second operation for irrigation and debridement. Two patients (3%) required implant removal.

Aggressive surgical treatment of postoperative spinal infections is essential for successful outcomes. Removal of implants is not necessary in acute infections. Delayed wound closure or second look operation could be avoided since primary closure offers accepted success rate.