title: Spinal instrumentation in patients with primary spinal infections does not lead to greater recurrent infection rates: an analysis of 118 cases.
abstract: OBJECTIVE
  We sought to compare outcomes between patients undergoing decompression only versus decompression and instrumented fusion for primary spinal infections.
  
  
  METHODS
  Records of patients with a diagnosis of primary spinal infection who underwent surgical management at our institution during a 10-year period were reviewed. Patients were divided into 2 cohorts based on treatment received (decompression alone vs. decompression and instrumentation). Our primary end points were complication rates, need for reoperation, recurrent infections, and resolution of symptom(s) at last follow-up.
  
  
  RESULTS
  A total of 118 patients underwent surgical management for primary spinal infections. Thirty-five patients presented with a cervical spine infection, 40 with a thoracic infection, and 43 with a lumbosacral infection. The mean age at presentation was 57.1 ± 13.5 years. Thirty-six patients underwent only decompression, and 82 underwent decompression and instrumented fusion. In the decompression-only group, 8.33% of patients had continued osteomyelitis/discitis compared with 9.76% of patients in the instrumented group (P = 0.807). Importantly, the reoperation rate was also similar between the decompression-only group (19.44%) and the instrumented group (17.07%; P = 0.756). Similarly, subanalyses based on infection location revealed no significant increase in rates of recurrent infection or reoperation in patients who underwent instrumentation.
  
  
  CONCLUSIONS
  Patients who received just decompression for spinal infection had similar reoperation and continued infection rates as patients who additionally underwent instrumentation, irrespective of infection location within the spine. These findings suggest that instrumentation of the infected spine may be a safe treatment modality and should be considered when the spinal integrity is compromised.
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Naumann
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. Electronic address: twitham2@jhmi.edu.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D000368:Aged; D002494:Central Nervous System Infections / Q000453:epidemiology* / Q000628:therapy; D019299:Decompression, Surgical / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000150:complications* / Q000601:surgery*; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Discitis; Epidural abscess; Spinal fusion; Vertebral osteomyelitis