Postoperative Spine Infection: Diagnosis and Management

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2018 Dec 22

PMID 30574436

Citations 30

Authors

James Dowdell

Robert Brochin

Jun Kim

Samuel Overley

Jonathan Oren

Brett Freedman

Samuel Cho

Affiliations

Soon will be listed here.

Abstract

Study Design: Review article.

Objectives: A review of the literature on postoperative spinal infections, their diagnosis, and management.

Methods: A systematic computerized Medline literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The electronic databases were searched for publication dates from the last 10 years. The searches were performed from Medical Subject Headings (MeSH) used by the National Library of Medicine. Specifically, MeSH terms "spine," "infections," "management," and "diagnosis" were used.

Results: Currently, the gold standard for diagnosis of postoperative spine infection is positive deep wound culture. Many of the current radiologic and laboratory tests can assist with the initial diagnosis and monitoring treatment response. Currently erythrocyte sedimentation rate, C-reactive protein, computed tomography scan, and magnetic resonance imaging with and without contrast are used in combination to establish diagnosis. Management of postoperative spine infection involves thorough surgical debridement and targeted antibiotic therapy.

Conclusions: Postoperative spine infection is a not uncommon complication following surgery that may have devastating consequences for a patient's short- and long-term health. A high index of suspicion is needed to make an early diagnosis.

Citing Articles

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Miyamoto A, Tanaka M, Flores A, Yu D, Jain M, Heng C Diagnostics (Basel). 2024; 14(23).

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References

Clark C, Shufflebarger H . Late-developing infection in instrumented idiopathic scoliosis. Spine (Phila Pa 1976). 1999; 24(18):1909-12. DOI: 10.1097/00007632-199909150-00008. View

Brown E, Pople I, de Louvois J, Hedges A, Bayston R, Eisenstein S . Spine update: prevention of postoperative infection in patients undergoing spinal surgery. Spine (Phila Pa 1976). 2004; 29(8):938-45. DOI: 10.1097/00007632-200404150-00023. View

Beiner J, Grauer J, Kwon B, Vaccaro A . Postoperative wound infections of the spine. Neurosurg Focus. 2004; 15(3):E14. DOI: 10.3171/foc.2003.15.3.14. View

Kowalski T, Berbari E, Huddleston P, Steckelberg J, Mandrekar J, Osmon D . The management and outcome of spinal implant infections: contemporary retrospective cohort study. Clin Infect Dis. 2007; 44(7):913-20. DOI: 10.1086/512194. View

Chaudhary S, Vives M, Basra S, Reiter M . Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med. 2007; 30(5):441-51. PMC: 2141723. DOI: 10.1080/10790268.2007.11753476. View

Mok J, Pekmezci M, Piper S, Boyd E, Berven S, Burch S . Use of C-reactive protein after spinal surgery: comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications. Spine (Phila Pa 1976). 2008; 33(4):415-21. DOI: 10.1097/BRS.0b013e318163f9ee. View

Forsberg J, Elster E, Andersen R, Nylen E, Brown T, Rose M . Correlation of procalcitonin and cytokine expression with dehiscence of wartime extremity wounds. J Bone Joint Surg Am. 2008; 90(3):580-8. DOI: 10.2106/JBJS.G.00265. View

Canavese F, Gupta S, Krajbich J, Emara K . Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg Br. 2008; 90(3):377-81. DOI: 10.1302/0301-620X.90B3.19890. View

Di Silvestre M, Bakaloudis G, Lolli F, Giacomini S . Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J. 2011; 20 Suppl 1:S121-7. PMC: 3087047. DOI: 10.1007/s00586-011-1754-1. View

10.

Larsson A, Uusijarvi J, Lind F, Gustavsson B, Saraste H . Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity. Eur Spine J. 2011; 20(12):2217-22. PMC: 3229727. DOI: 10.1007/s00586-011-1797-3. View

11.

Lazennec J, Fourniols E, Lenoir T, Aubry A, Pissonnier M, Issartel B . Infections in the operated spine: update on risk management and therapeutic strategies. Orthop Traumatol Surg Res. 2011; 97(6 Suppl):S107-16. DOI: 10.1016/j.otsr.2011.07.002. View

12.

Bible J, Biswas D, Devin C . Postoperative infections of the spine. Am J Orthop (Belle Mead NJ). 2012; 40(12):E264-71. View

13.

Herrera Herrera I, Moreno de la Presa R, Gonzalez Gutierrez R, Barcena Ruiz E, Garcia Benassi J . Evaluation of the postoperative lumbar spine. Radiologia. 2012; 55(1):12-23. DOI: 10.1016/j.rx.2011.12.004. View

14.

Hayashi D, Roemer F, Mian A, Gharaibeh M, Muller B, Guermazi A . Imaging features of postoperative complications after spinal surgery and instrumentation. AJR Am J Roentgenol. 2012; 199(1):W123-9. DOI: 10.2214/AJR.11.6497. View

15.

Hegde V, Meredith D, Kepler C, Huang R . Management of postoperative spinal infections. World J Orthop. 2013; 3(11):182-9. PMC: 3547112. DOI: 10.5312/wjo.v3.i11.182. View

16.

Nunez-Pereira S, Pellise F, Rodriguez-Pardo D, Pigrau C, Bago J, Villanueva C . Implant survival after deep infection of an instrumented spinal fusion. Bone Joint J. 2013; 95-B(8):1121-6. DOI: 10.1302/0301-620X.95B8.30784. View

17.

Glaudemans A, de Vries E, Galli F, Dierckx R, Slart R, Signore A . The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol. 2013; 2013:623036. PMC: 3763592. DOI: 10.1155/2013/623036. View

18.

Nakahara M, Ito M, Hattori N, Magota K, Takahata M, Nagahama K . 18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery. Acta Radiol. 2014; 56(7):829-36. DOI: 10.1177/0284185114541983. View

19.

Lall R, Wong A, Lall R, Lawton C, Smith Z, Dahdaleh N . Evidence-based management of deep wound infection after spinal instrumentation. J Clin Neurosci. 2014; 22(2):238-42. DOI: 10.1016/j.jocn.2014.07.010. View

20.

Chahoud J, Kanafani Z, Kanj S . Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med (Lausanne). 2015; 1:7. PMC: 4335387. DOI: 10.3389/fmed.2014.00007. View