ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2022
Management and outcome of spinal implant-associated surgical site infections in patients with posterior instrumentation: analysis of 176 cases.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Two-Year Outcomes of Postoperative Spine Infection: Implant Retention and Predictors of Treatment Failure.Open forum infectious diseases · 2026Article
- Systemic immune responses in patients with spine surgery related infections.Frontiers in immunology · 2026Article
- Early vs. Late Unplanned Returns to the Operating Room (URTOR) in Neurosurgery: Effect of Surgeon Experience and Complication Types.Medicina (Kaunas, Lithuania) · 2025Article
- Management and outcome of whole-spine epidural abscesses - institutional case series and systematic review.Brain & spine · 2025Review
- Visceral fat: the hidden culprit behind thoracolumbar surgery infections.Frontiers in surgery · 2025Article
- The pathogenicity and virulence of the opportunistic pathogenVirulence · 2024Review
- Does intraoperative wound irrigation with diluted povidone-iodine prevent surgical site infection in spine surgery?EFORT open reviews · 2024Article
- Defeating the Hidden Foe: Antibiotic Therapy and Clinical Outcomes ofOpen forum infectious diseases · 2023Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe management of implant-associated surgical site infections (SSI) in patients with posterior instrumentation is challenging. Evidence regarding the most appropriate treatment and the need for removal of implants is equivocal. We sought to evaluate the management and outcome of such patients at our institution.
methodsWe searched our prospectively documented databases for eligible patients with posterior spinal instrumentation, excluding the cervical spine (January 2008-June 2018). Patient files were reviewed, demographic data and treatment details were recorded. Patient-reported outcome (PRO) was assessed with the Core Outcome Measures Index (COMI) preoperatively and postoperatively at 3 and 12 months.
resultsA total of 170 patients underwent 210 revisions for 176 SSIs. Two-thirds presented within four weeks (105/176, 59.7%, median 22.5d, 7d-11.1y). The most common pathogens were Staphylococcus aureus (n = 79/210, 37.6%) and Staphylococcus epidermidis (n = 56/210, 26.7%). Debridement and implant retention was performed in 135/210 (64.3%) revisions and partial replacement in 62/210 (29.5%). In 28/176 SSI (15.9%), persistent infection required multiple revisions (≤ 4). Surgery was followed by intravenous and oral antimicrobial treatment (10-12w). In 139/176 SSIs (79%) with ≥ 1y follow-up, infection was cured in 115/139 (82.7%); relapse occurred in 9 (relapse rate: 5.1%). Two patients (1.4%) died. COMI decreased significantly (8.2 ± 1.5 vs. 4.8 ± 2.9, p < 0.0001) over 12 months. 72.7% of patients were (very) satisfied with their care.
conclusionPatients with SSI after posterior (thoraco-)lumbo(-sacral) instrumentation can be successfully treated in most cases with surgical and specific antibiotic treatment. An interdisciplinary approach is recommended. Loose implants should be replaced. In some cases, multiple revisions may be necessary. Patient outcomes were satisfactory.
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