Closed suction irrigation for the treatment of postoperative wound infections following posterior spinal fusion and instrumentation.
METHODS
Retrospective review of clinical cases.


OBJECTIVE
This study describes the success rate of closed suction irrigation system (CSIS) in the treatment of post operative spinal infections.


BACKGROUND
Given the widening use of spinal instrumentation, the management of related postoperative deep wound infections has become increasingly important. In the literature, there have been reports of several treatment methods yet no firmly established protocol for management of postoperative deep wound infections exists. The goal of this study was to determine the effectiveness of our protocol employing (CSIS) in the treatment of postoperative deep wound infections.


METHODS
A retrospective record review of 500 posterior instrumented fusions between 1990 and 2002. Twenty-eight consecutive infections (5%) were diagnosed and treated by a standardized treatment protocol of Incision and Drainage, and CSIS. Cultures were obtained, wounds closed primarily, and appropriate intravenous antibiotic treatments initiated. For statistical evaluation, patients were assigned a risk factor (RF) described by Levi et al (J Neurosurg. 1997;86:975-980). Point values were assigned to medical comorbidities that may contribute to postoperative infection risk; higher RF values indicate an increased risk.


RESULTS
Twenty-one acute and 7 late (>6 months) infections were followed for 22.3 months (1-86 months), post-CSIS treatment. Twenty-one (75%) resolved without recurrence with one CSIS treatment. Seven acute infections (25%) required a second course of treatment. Hospitalization for the index procedure averaged 15.4 days; 28.9 days for reinfections. No patient with an acute infection required implant removal. The reinfection group had higher blood loss, more levels fused, and longer hospitalization. The reinfection group was comprised entirely of pediatric patients.


CONCLUSIONS
No correlation was found between RF values and greater risk of recurrent infection. Removal of implants is unnecessary in acute infections, provided the infection does not return. CSIS is an effective method for treatment of postoperative wound infections following instrumented spinal fusion avoiding the need for secondary closure.
From the *Cincinnati Spine Institute, Cincinnati, OH; †Department of Orthopedics, University of California, San Diego, CA; ‡San Diego Center for Spinal Disorders, La Jolla, CA; §Kaiser Permanente, San Diego, CA; and ¶La Jolla Spine Institute, La Jolla, CA.
Michael T
MT
Rohmiller
Behrooz A
BA
Akbarnia
Kian
K
Raiszadeh
Kamshad
K
Raiszadeh
Sarah
S
Canale
D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013396:Suction; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents