title: Impact of surgical site infection and surgical debridement on lumbar arthrodesis: A single-institution analysis of incidence and risk factors.
abstract: This study identifies the rate of pseudarthrosis following surgical debridement for deep lumbar spine surgical site infection and identify associated risk factors. Patients who underwent index lumbar fusion surgery from 2013 to 2014 were included if they met the following criteria: 1) age >18years, 2) had debridement of deep lumbar SSI, and had 3) lumbar spine AP, lateral and flexion/extension X-rays and computed tomography (CT) at 12months or greater postoperatively. Criteria for fusion included 1) solid posterolateral, facet, or disk space bridging bone, 2) no translational or angular motion on flexion/extension X-rays, and 3) intact posterior hardware without evidence of screw lucency or breakage. Twenty-five patients (age 63.2±12.6years, 10 male) involving 58 spinal levels met inclusion criteria. They underwent fusion at a mean of 2.32 [range 1-4] spinal levels. Sixteen (64.0%) patients received interbody grafts at a total of 34 (58.6%) spinal levels. All underwent surgical debridement with removal of all non-incorporated posterior bone graft and devascularized tissue. At one-year postoperatively, (56%) patients and 30 (52%) spinal levels demonstrated radiographic evidence of successful fusion. Interbody cage during initial fusion was significantly associated with successful arthrodesis at follow-up (p=0.017). There is a high rate of pseudoarthrosis in 44% of patients (48% of levels) undergoing lumbar fusion surgery complicated by SSI requiring debridement. Use of interbody cage during initial fusion was significantly associated with higher rate of arthrodesis.
authors.affiliation: Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Timothy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Back
authors.affiliation: Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Eliza
authors.initials: E
authors.lastname: Hompe
authors.affiliation: Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wall
authors.affiliation: Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: oren.gottfried@dm.duke.edu.
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000009:adverse effects / Q000639:trends; D001863:Bone Screws / Q000009:adverse effects; D003646:Debridement / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends; D013530:Surgical Wound Infection / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Fusion; Interbody cage; Irrigation and debridement; Lumbar spine; Pseudoarthrosis; Surgical site infection