title: What is new in the diagnosis and prevention of spine surgical site infections.
abstract: BACKGROUND
  Surgical site infection (SSI) after spinal surgery can result in several serious secondary complications, such as pseudoarthrosis, neurological injury, paralysis, sepsis, and death. There is an increasing body of literature on risk factors, diagnosis, and specific intraoperative interventions, including attention to sterility of instrumentation, application of minimally invasive fusion techniques, intraoperative irrigation, and application of topical antibiotics, that hold the most promise for reduction of SSI.
  
  
  OBJECTIVE
  The purpose of this review is to identify and summarize the recent literature on the incidence, risk factors, diagnosis, prevention, and treatment of SSIs after adult spine surgery.
  
  
  METHODS
  The study design included systematic review and literature synthesis.
  
  
  METHODS
  For the systematic reviews, a search was performed in Medline and Scopus using keywords derived from a preliminary review of the literature and Medline MeSH terms. These studies were then manually filtered to meet the study criteria outlined in each section. Studies were excluded via predetermined criteria, and the majority of articles reviewed were excluded.
  
  
  RESULTS
  There are a number of patient- and procedure-specific risk factors for SSI. Surgical site infection appears to have significant implications from the patients' perspective on outcome of care. Diagnosis of SSI appears to rely primarily on clinical factors, while laboratory values such as C-reactive protein are not universally sensitive. Similarly, novel methods of perioperative infection prophylaxis such as local antibiotic administration appear to be modestly effective.
  
  
  CONCLUSIONS
  Surgical site infections are a common multifactorial problem after spine surgery. There is compelling evidence that improved risk stratification, detection, and prevention will reduce SSIs.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA. Electronic address: kris.radcliff@rothmaninstitute.com.
authors.forename: Kris E
authors.initials: KE
authors.lastname: Radcliff
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA; Department of Surgery, Temple University Hospital, 3401 N. Broad St, Suite 400, Philadelphia, PA 19140, USA.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Neusner
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Millhouse
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Harrop
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D006801:Humans; D015994:Incidence; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*
keywords: Fusion; Inflammatory markers; Spinal infection; Spinal instrumentation; Surgical wound infection; Topical antibiotics