Management of deep wound infection after posterior lumbar interbody fusion with cages.
OBJECTIVE
To evaluate long-term treatment outcome of patients with infected posterior lumbar interbody fusion (PLIF) managed with surgical debridement and or prolonged antiobiotic treatment without removal of the interbody cages.


METHODS
Between 1996 and 1999, 8 out of 111 patients who underwent PLIF were diagnosed with deep wound infection (7.2%). All infected patients were clinically followed for at least 2 years after completion of the antibiotic treatment. Longer follow-up of at least 6 years duration was performed by a telephone interview.


RESULTS
Six patients were managed with surgical debridement, wound irrigation, and primary closure of the wound. None of the patients required removal of the instrumentation. In 2 patients, the PLIF cages were repositioned in the face of infection. All 8 patients received 4 to 6 weeks of intravenous antibiotic therapy followed by another 6 to 9 weeks of oral antibiotic administration. At 2-year follow-up, no clinical or laboratory signs of recurrent infection were evident. Four of the 8 patients reported improved clinical status compared with their prefusion status. At 6-year follow-up, 3 patients had minimal disability according to the Oswestry Disability Index and 2 patients had moderate disability with residual leg pain.


CONCLUSIONS
In cases of postoperative deep wound infection after PLIF with cages, removal of the interbody implants is not necessary. Treatment is composed of prolonged antibiotic therapy guided by antimicrobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.
Mirovsky
Yigal
Y
Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
Floman
Yizhar
Y
Smorgick
Yossi
Y
Ashkenazi
Ely
E
Anekstein
Yoram
Y
Millgram
Michael A
MA
Giladi
Michael
M
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001860:Bone Plates / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents