title: The diagnosis and management of infection following instrumented spinal fusion.
abstract: A 10-year retrospective audit. (1) The incidence of infection; (2) causative organisms; (3) whether eradication of infection is achievable with spinal implant retention; (4) patient outcome. The reported incidence of infection following posterior spinal instrumentation is between 2.6 and 3.8%. Management of infection is controversial, with some advocating serial wound debridement while others report that infection cannot be eradicated with retention of implants. There are no published data demonstrating that propionibacteria are associated with early postoperative infection. The management of infected cases at our institution includes eventual removal of their implants. Our population was identified by studying the case notes of all patients who had undergone removal of spinal implants and cross-referencing this population with positive microbiology or histology reports. The incidence of infection was 3.7%. Propionibacteria were isolated in 45% of cases. The diagnosis of infection was unexpected in 25% of patients, following removal of implants for prominence of implants or back pain. Sixty per cent of patients with acute postoperative deep wound infection had continuing active infection on subsequent removal of implants, despite long-term antibiotics and wound debridement. Fourty-six per cent of patients had a stable, pain-free spine at the end of their treatment. This is the largest reported series of infections following posterior spinal instrumented fusions of which we are aware. Propionibacteria are a common cause of infection and successful eradication of infection cannot be reliably achieved with antibiotics and wound debridement alone.
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK.
authors: Iona
authors: I
authors: Collins
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK. james.wilsonmacdonald@noc.anglox.nhs.uk.
authors: James
authors: J
authors: Wilson-MacDonald
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK.
authors: George
authors: G
authors: Chami
authors: , Epsom, UK.
authors: Will
authors: W
authors: Burgoyne
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK.
authors: P
authors: P
authors: Vinayakam
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK.
authors: Tony
authors: T
authors: Berendt
authors: Department of Spinal Surgery, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7LD, UK.
authors: Jeremy
authors: J
authors: Fairbank
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002985:Clinical Protocols; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011424:Propionibacterium / Q000302:isolation & purification; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013166:Spondylitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents