Volume 4, Issue 1 (Winter 2018)                   Iran J Neurosurg 2018, 4(1): 5-12 | Back to browse issues page

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Emamhadi M, Ghadarjani S, Nozari Golsefid H. Post-Operative Infections in Spine Procedures: A Brief Review. Iran J Neurosurg. 2018; 4 (1) :5-12
URL: http://irjns.org/article-1-101-en.html
1- Associate Professor of Neurosurgery, Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Guilan, Iran , mr.emamhadi@gmail.com
2- Assistant Professor of Neurosurgery, Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Guilan, Iran
3- Resident of Neurosurgery, Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Guilan, Iran
Abstract:   (1078 Views)

Background and Aim: Surgical site infection is an important complication after spinal surgery. Prevention and treatment of this complication requires more and reliable information. In this article, we investigated the epidemiology, pathogenesis, diagnosis and treatment of post-operative infection in spine procedures by reviewing previous related studies.
Methods and Materials/Patients: In this paper, original articles available in PubMed and Scopus published between 1991 and 2017 were reviewed and studied.
Results: Organisms resistant to antibiotics have increased and made treatment harder, especially in patients with instrumentation of spine. The frequency of surgical site infection depends on surgical technique, anatomical location, and duration of surgery.
Conclusion: Prevention is the best way to reduce the frequency of post-spinal surgical infection. Excessive use of antibiotics increases the risk of infection with bacteria resistant to treatment.

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Type of Study: Research | Subject: Spine

1. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: A review of 2,391 consecutive index procedures. Journal of Spinal Disorders & Techniques. 2000; 13(5):422-6. [PMID] [DOI:10.1097/00002517-200010000-00009]
2. Thalgott JS, Cotler HB, Sasso RC, LaRocca H, Gardner V. Postoperative infections in spinal implants classification and analysis-a multicenter study. Spine. 1991; 16(8):981-4. [DOI:10.1097/00007632-199108000-00020] [PMID] [DOI:10.1097/00007632-199108000-00020]
3. Horan TC, Culver DH, Gaynes RP, Jarvis WR, Edwards JR, Reid CR. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System. Infection Control & Hospital Epidemiology. 1993; 14(2):73-80. [PMID] https://doi.org/10.2307/30147164 [DOI:10.1086/646686] [PMID]
4. Veeravagu A, Patil CG, Lad SP, Boakye M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine. 2009; 34(17):1869-72. [DOI:10.1097/BRS.0b013e3181adc989] [PMID] [DOI:10.1097/BRS.0b013e3181adc989]
5. Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009; 34(13):1422-8. [DOI:10.1097/BRS.0b013e3181a03013] [PMID] [DOI:10.1097/BRS.0b013e3181a03013]
6. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005; 30(12):1460-5. [DOI:10.1097/01.brs.0000166532.58227.4f] [PMID] [DOI:10.1097/01.brs.0000166532.58227.4f]
7. Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, et al. Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine. 2011; 36(7):556-63. [DOI:10.1097/BRS.0b013e3181eadd41] [PMID] [DOI:10.1097/BRS.0b013e3181eadd41]
8. Levi AD, Dickman CA, Sonntag VK. Management of postoperative infections after spinal instrumentation. Journal of Neurosurgery. 1997; 86(6):975-80. [DOI:10.3171/jns.1997.86.6.0975] [PMID] [DOI:10.3171/jns.1997.86.6.0975]
9. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, McCormick P. Management of postprocedural discitis. The spine Journal : Official Journal of the North American Spine Society. 2002; 2(4):279-87. [DOI:10.1016/S1529-9430(02)00203-6] [DOI:10.1016/S1529-9430(02)00203-6]
10. Lindholm TS, Pylkkanen P. Discitis following removal of intervertebral disc. Spine. 1982; 7(6):618-22. [DOI:10.1097/00007632-198211000-00018] [DOI:10.1097/00007632-198211000-00018]
11. Tyler KL. Acute pyogenic diskitis (spondylodiskitis) in adults. Reviews in Neurological Diseases. 2008; 5(1):8-13. [PMID] [PMID]
12. Tronnier V, Schneider R, Kunz U, Albert F, Oldenkott P. Postoperative spondylodiscitis: results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation. Acta Neurochirurgica. 1992; 117(3-4):149-52. [DOI:10.1007/BF01400612] [DOI:10.1007/BF01400612]
13. Chaudhary SB, Vives MJ, Basra SK, Reiter MF. Postoperative spinal wound infections and postprocedural diskitis. The Journal of Spinal Cord Medicine. 2007; 30(5):441-51. [DOI:10.1080/10790268.2007.11753476] [PMID] [PMCID] [DOI:10.1080/10790268.2007.11753476]
14. Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR. Postoperative posterior spinal wound infections. Clinical Orthopaedics and Related Research. 1992; 284:99-108. [DOI:10.1097/00003086-199211000-00013] [DOI:10.1097/00003086-199211000-00013]
15. Bassewitz HL, Fischgrund J, Herkowitz HN. Academic longevity and attrition of full-time orthopaedic faculty members. The Journal of Bone and Joint Surgery. 2000; (7): 1042-8. [PMID] [PMID]
16. Christodoulou AG, Givissis P, Symeonidis PD, Karataglis D, Pournaras J. Reduction of postoperative spinal infections based on an etiologic protocol. Clinical Orthopaedics and Related Research. 2006; 444:107-13. [DOI:10.1097/01.blo.0000201174.10506.cc ] [PMID] [DOI:10.1097/01.blo.0000201174.10506.cc]
17. Sasso RC, Garrido BJ. Postoperative spinal wound infections. The Journal of the American Academy of Orthopaedic Surgeons. 2008; 16(6):330-7. [DOI:10.5435/00124635-200806000-00005] [DOI:10.5435/00124635-200806000-00005]
18. Herkowitz H, Garfin S, Eismont F, Bell G, Balderston R. Rothman-Simeone The Spine. Amsterdam: Elsevier Health Sciences; 2011. [PMCID]
19. Horwitz NH, Curtin JA. Prophylactic antibiotics and wound infections following laminectomy for lumber disc herniation. Journal of Neurosurgery. 1975; 43(6):727-31. [DOI:10.3171/jns.1975.43.6.0727] [PMID] [DOI:10.3171/jns.1975.43.6.0727]
20. Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP, Jr., Finerty EA, Nguyen JT, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. The Journal of Bone and Joint Surgery American Volume. 2011;93(17):1627-33. [DOI:10.2106/JBJS.J.00039] [PMID] [DOI:10.2106/JBJS.J.00039]
21. Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. Journal of Orthopaedic Trauma. 2001; 15(8):566-9. [DOI:10.1097/00005131-200111000-00006] [PMID] [DOI:10.1097/00005131-200111000-00006]
22. Cunningham ME, Girardi F, Papadopoulos EC, Cammisa FP. Spinal infections in patients with compromised immune systems. Clinical Orthopaedics and Related Research. 2006; 444:73-82. [DOI:10.1097/01.blo.0000201176.87635.f3] [PMID] [DOI:10.1097/01.blo.0000201176.87635.f3]
23. Patel H, Khoury H, Girgenti D, Welner Sh, Yu H. Burden of surgical site infections associated with select spine operations and involvement of staphylococcus aureus. Surgical Infections. 2017; 18(4):461-73. [DOI:10.1089/sur.2016.186] [PMID] [PMCID]
24. Hidron AI, Kourbatova EV, Halvosa JS, Terrell BJ, McDougal LK, Tenover FC, et al. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: Amergence of community-associated MRSA nasal carriage. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2005; 41(2):159-66. [DOI:10.1086/430910] [PMID] [DOI:10.1086/430910]
25. Slover J, Haas JP, Quirno M, Phillips MS, Bosco JA. Cost-effectiveness of a Staphylococcus aureus screening and decolonization program for high-risk orthopedic patients. The Journal of Arthroplasty. 2011; 26(3):360-5. [DOI:10.1016/j.arth.2010.03.009] [PMID] [DOI:10.1016/j.arth.2010.03.009]
26. Rubinstein E, Findler G, Amit P, Shaked I. Perioperative prophylactic cephazolin in spinal surgery. A Double-Blind
27. Placebo-Controlled Trial. The Bone and Joint Journal. 1994; 76(1):99-102. [DOI:10.1302/0301-620X.76B1.8300691] [PMID] [DOI:10.1302/0301-620X.76B1.8300691]
28. Wimmer C, Gluch H, Franzreb M, Ogon M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. Journal of Spinal Disorders. 1998; 11(2):124-8. [DOI:10.1097/00002517-199804000-00006] [PMID] [DOI:10.1097/00002517-199804000-00006]
29. Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. The Journal of Surgical Research. 2002; 103(1):89-95. [DOI:10.1006/jsre.2001.6343] [PMID] [DOI:10.1006/jsre.2001.6343]
30. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. The Journal of Bone and Joint Surgery American Volume. 2008; 90(1):62-9. [DOI:10.2106/JBJS.F.01515] [PMID] [DOI:10.2106/JBJS.F.01515]
31. Klein JD, Hey LA, Yu CS, Klein BB, Coufal FJ, Young EP, et al. Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine. 1996; 21(22):2676-82. [DOI:10.1097/00007632-199611150-00018] [PMID] [DOI:10.1097/00007632-199611150-00018]
32. Dick J, Boachie-Adjei O, Wilson M. One-stage versus two-stage anterior and posterior spinal reconstruction in adults. Comparison of outcomes including nutritional status, complications rates, hospital costs, and other factors. Spine. 1992;17(8 Suppl):S310-6. [DOI:10.1090007632-199208001-00017] [PMID] [DOI:10.1097/00007632-199208001-00017] [PMID]
33. Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, et al. Obesity and spine surgery: relation to perioperative complications. Journal of Neurosurgery Spine. 2007; 6(4):291-7. [DOI:10.3171/spi.2007.6.4.1] [PMID] [DOI:10.3171/spi.2007.6.4.1]
34. Capen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusions. The Orthopedic Clinics of North America. 1996; 27(1):83-6. [PMID] [PMID]
35. Carragee EJ. Pyogenic vertebral osteomyelitis. The Journal of Bone and Joint Surgery American Volume. 1997;79(6):874-80. [DOI:10.2106/00004623-199706000-00011] [PMID] [DOI:10.2106/00004623-199706000-00011]
36. Simionescu R, Grover S, Shekar R, West BC. Necrotizing fasciitis caused by Erysipelothrix rhusiopathiae. Southern Medical Journal. 2003; 96(9):937-9. [DOI:10.1097/01.SMJ.0000051742.81317.E9] [PMID] [DOI:10.1097/01.SMJ.0000051742.81317.E9]
37. Gelalis ID, Arnaoutoglou CM, Politis AN, Batzaleksis NA, Katonis PG, Xenakis TA. Bacterial wound contamination during simple and complex spinal procedures. A prospective clinical study. The Spine Journal: Official Journal of the North American Spine Society. 2011; 11(11):1042-8. [DOI:10.1016/j.spinee.2011.10.015] [PMID] [DOI:10.1016/j.spinee.2011.10.015]
38. Keller RB, Pappas AM. Infection after spinal fusion using internal fixation instrumentation. The Orthopedic Clinics of North America. 1972; 3(1):99-111. [PMID] [PMID]
39. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, et al. Risk factors for surgical site infection in spinal surgery. Journal of Neurosurgery: Spine. 2003; 98(2):149-55. [DOI:10.3171/spi.2003.98.2.0149] [DOI:10.3171/spi.2003.98.2.0149]
40. Glassman SD, Dimar JR, Puno RM, Johnson JR. Salvage of instrumental lumbar fusions complicated by surgical wound infection. Spine. 1996; 21(18):2163-9. [DOI:10.1097/00007632-199609150-00021] [PMID] [DOI:10.1097/00007632-199609150-00021]
41. Schuster JM, Rechtine G, Norvell DC, Dettori JR. The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine. 2010; 35(9):S125-37. [DOI:10.1097/BRS.0b013e3181d8342c] [PMID] [DOI:10.1097/BRS.0b013e3181d8342c]
42. Khan IU, Janjua MB, Hasan S, Shah S. Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study.Journal of Ayub Medical College Abbottabad. 2009; 21(3):135-8. [PMID]
43. Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O. Postoperative infections of the lumbar spine: presentation and management. International Orthopaedics. 2012; 36(2):439-44. [DOI:10.1007/s00264-011-1427-z] [PMID] [PMCID] [DOI:10.1007/s00264-011-1427-z]
44. Watters WC, 3rd, Baisden J, Bono CM, Heggeness MH, Resnick DK, Shaffer WO, et al. Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery. The Spine Journal: Official Journal of the North American Spine Society. 2009; 9(2):142-6. [DOI:10.1016/j.spinee.2008.05.008] [PMID] [DOI:10.1016/j.spinee.2008.05.008]
45. Brown MD, Brookfield KF. A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine. 2004; 29(10):1066-8. [DOI:10.1097/00007632-200405150-00003] [DOI:10.1097/00007632-200405150-00003]
46. Beer KJ, Lombardi AV, Jr., Mallory TH, Vaughn BK. The efficacy of suction drains after routine total joint arthroplasty. The Journal of Bone and Joint Surgery American Volume. 1991; 73(4):584-7. [DOI:10.2106/00004623-199173040-00015] [PMID] [DOI:10.2106/00004623-199173040-00015]
47. Celik SE, Kara A. Does shaving the incision site increase the infection rate after spinal surgery? Spine. 2007; 32(15):1575-7. [DOI:10.1097/BRS.0b013e318074c39f] [PMID] [DOI:10.1097/BRS.0b013e318074c39f]
48. Harris AE, Hennicke C, Byers K, Welch WC. Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature. Surgical Neurology. 2005; 63(6):538-41; discussion 41. [DOI:10.1016/j.surneu.2004.06.012] [PMID] [DOI:10.1016/j.surneu.2004.06.012]
49. Walid MS, Woodall MN, Nutter JP, Ajjan M, Robinson JS, Jr. Causes and risk factors for postoperative fever in spine surgery patients. Southern Medical Journal. 2009; 102(3):283-6. [DOI:10.1097/SMJ.0b013e31819676a4] [PMID] [DOI:10.1097/SMJ.0b013e31819676a4]
50. Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine. 2000; 25(19):2461-6. [DOI:10.1097/00007632-200010010-00007] [PMID] [DOI:10.1097/00007632-200010010-00007]
51. Butler JS, Devitt BM, Poynton AR. Hong HS, Chang MC, Liu CL, et al. Is aggressive surgery necessary for acute postoperative deep spinal wound infection? Spine. 2009; 34(7):751-2; author reply [DOI: 10.1097/BRS.0b013e31819d080d] [PMID] [DOI:10.1097/BRS.0b013e31819d080d]
52. Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, et al. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. Journal of Spinal Disorders. 2000; 13(1):42-5. [DOI:10.1097/00002517-200002000-00009] [PMID] [DOI:10.1097/00002517-200002000-00009]
53. Labler L, Keel M, Trentz O, Heinzelmann M. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery. European Spine Journal. 2006; 15(9):1388-96. [DOI:10.1007/s00586-006-0164-2] [PMID] [PMCID] [DOI:10.1007/s00586-006-0164-2]
54. Mehbod AA, Ogilvie JW, Pinto MR, Schwender JD, Transfeldt EE, Wood KB, et al. Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. Journal of Spinal Disorders & Techniques. 2005; 18(1):14-7. [DOI:10.1097/01.bsd.0000133493.32503.d3] [DOI:10.1097/01.bsd.0000133493.32503.d3]
55. Pull ter Gunne AF, Mohamed AS, Skolasky RL, van Laarhoven CJ, Cohen DB. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine. 2010; 35(13):1323-8. [DOI:10.1097/BRS.0b013e3181bcde61] [PMID] [DOI:10.1097/BRS.0b013e3181bcde61]
56. Watanabe M, Sakai D, Matsuyama D, Yamamoto Y, Sato M, Mochida J. Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. Journal of Neurosurgery Spine. 2010; 12(5):540-6. [DOI:10.3171/2009.11.SPINE09308] [PMID] [DOI:10.3171/2009.11.SPINE09308]
57. Sierra-Hoffman M, Jinadatha C, Carpenter JL, Rahm M. Postoperative instrumented spine infections: a retrospective review. Southern Medical Journal. 2010; 103(1):25-30. [DOI:10.1097/SMJ.0b013e3181c4e00b] [PMID] [DOI:10.1097/SMJ.0b013e3181c4e00b]
58. Pappou IP, Papadopoulos EC, Sama AA, Girardi FP, Cammisa FP. Postoperative infections in interbody fusion for degenerative spinal disease. Clinical Orthopaedics and Related Research. 2006; 444:120-8. [DOI:10.1097/01.blo.0000203446.06028.b5] [PMID] [DOI:10.1097/01.blo.0000203446.06028.b5]
59. Gerometta A, Rodriguez Olaverri JC, Bitan F. Infections in spinal instrumentation. International Orthopaedics. 2012; 36(2):457-64. [DOI:10.1007/s00264-011-1426-0] [PMID] [PMCID] [DOI:10.1007/s00264-011-1426-0]
60. Ahmed R, Greenlee JD, Traynelis VC. Preservation of spinal instrumentation after development of postoperative bacterial infections in patients undergoing spinal arthrodesis. Journal of Spinal Disorders & Techniques. 2012; 25(6):299-302. [DOI:10.1097/BSD.0b013e31821fbf72] [PMID] [DOI:10.1097/BSD.0b013e31821fbf72]
61. Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine. 1997; 22(20):2444-50. [DOI:10.1097/00007632-199710150-00023] [PMID] [DOI:10.1097/00007632-199710150-00023]
62. Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD. Treatment of postoperative wound infections following spinal fusion with instrumentation. Journal of Spinal Disorders. 1995; 8(4):278-83. [DOI:10.1097/00002517-199508040-00003] [PMID] [DOI:10.1097/00002517-199508040-00003]
63. Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology. 2001; 218(1):211-4. [DOI:10.1148/radiology.218.1.r01ja06211] [PMID] [DOI:10.1148/radiology.218.1.r01ja06211]
64. Ozuna RM, Delamarter RB. Pyogenic vertebral osteomyelitis and postsurgical disc space infections. The Orthopedic Clinics of North America. 1996; 27(1):87-94. [PMID] [PMID]
65. Visuri T, Pihlajamaki H, Eskelin M. Long-term vertebral changes attributable to postoperative lumbar discitis: a retrospective study of six cases. Clinical Orthopaedics and Related Research. 2005; (433):97-105. [DOI:10.1097/01.blo.0000151425.00945.2a] [PMID] [DOI:10.1097/01.blo.0000151425.00945.2a]
66. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clinical Infectious Diseases. 2011; 52(3):285-92. [DOI:10.1093/cid/ciq146] [PMID] [DOI:10.1093/cid/ciq146]

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