title: Postoperative infections of the lumbar spine: presentation and management.
abstract: OBJECTIVE
  Postoperative surgical site infections (SSI) are a frequent complication following posterior lumbar spinal surgery. In this manuscript we review strategies for prevention, diagnosis and treatment of SSI.
  
  
  METHODS
  The literature was reviewed using the Pubmed database.
  
  
  RESULTS
  We identified fifty-nine relevant manuscripts almost exclusively composed of Level III and IV studies.
  
  
  CONCLUSIONS
  Risk factors for SSI include: 1) factors related to the nature of the spinal pathology and the surgical procedure and 2) factors related to the systemic health of the patient. Staphylococcus aureus is the most common infectious organism in reported series. Proven methods to prevent SSI include prophylactic antibiotics, meticulous adherence to aseptic technique and frequent release of retractors to prevent myonecrosis. The presentation of SSI is varied depending on the virulence of the infectious organism. Frequently, increasing pain is the only presenting complaint and can lead to a delay in diagnosis. Magnetic resonance imaging and the use of C-reactive protein laboratory studies are useful to establish the diagnosis. Treatment of SSI is centered on surgical debridement of all necrotic tissue and obtaining intra-operative cultures to guide antibiotic therapy. We recommend the involvement of an infectious disease specialist and use of minimum serial bactericidal titers to monitor the efficacy of antibiotic treatment. In the most cases, SSI can be adequately treated while leaving spinal instrumentation in place. For severe SSI, repeat debridement, delayed closure and involvement of a plastic surgeon may be necessary.
authors.affiliation: Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery/Weill Cornell Medical Center, New York, NY, USA. meredithd@hss.edu
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Meredith
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Russel C
authors.initials: RC
authors.lastname: Huang
authors.forename: Barry D
authors.initials: BD
authors.lastname: Brause
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001174:Arthrodesis / Q000009:adverse effects; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D015299:Discitis / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein