title: Implant removal for the management of infection after instrumented spinal fusion.
abstract: METHODS
  We operated on 21 patients with a postoperative deep wound infection. All the patients underwent implant removal and wide debridement. One patient lost to follow-up was excluded.
  
  
  OBJECTIVE
  To reduce the number of debridements and manage uncontrolled spine infection.
  
  
  BACKGROUND
  There are a few reports on the treatment for postoperative spinal infection after instrumented spine fusion with implant removal and wide debridement.
  
  
  METHODS
  The clinical outcomes were assessed using the Oswestry disability index, visual analog scale of pain and patients' satisfaction.
  
  
  RESULTS
  The functional outcomes of the Oswestry disability index were minimal in 13 patients and moderate in 7 at final follow-up. The serial changes of visual analog scale score of pain in the back and leg showed statistically significant decline after operation. Patients' satisfaction outcomes were better in 16 patients and unchanged in 4. Six patients of the preoperative spinal fusion group included the patients that already had fusion mass well developed by the time of implant removal. Bony union was not achieved in any patient of the preoperative nonspinal fusion group (n=14) by the last follow-up. In nonspinal fusion group, mean lordotic angle before the operation was 41 degrees decreasing after the operation to 39 degrees. At the final follow-up it was 30 degrees. Mean disc space height before the operation was 11.1 mm and it decreased to 8.1 mm at the final follow-up. The mean lordotic angle and disc space height at last follow-up was larger in the spinal fusion group than in the nonspinal fusion group.
  
  
  CONCLUSIONS
  Our results indicate that implant removal and wide debridement for postoperative infection after posterior instrumented spine fusion can provide satisfactory results and could be one treatment option. However, the collapse of the disc space, loss of normal lordosis, and pseudoarthrosis are inevitable in patients with early postoperative infection.
authors.affiliation: Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Pusan, Korea.
authors.forename: Jeung Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Kuen Tak
authors.initials: KT
authors.lastname: Suh
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jung Sub
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011552:Pseudomonas Infections / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013203:Staphylococcal Infections / Q000601:surgery*; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000601:surgery*; D016896:Treatment Outcome