Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Nov 18, 2012; 3(11): 182-189
Published online Nov 18, 2012. doi: 10.5312/wjo.v3.i11.182
Management of postoperative spinal infections
Vishal Hegde, Dennis S Meredith, Christopher K Kepler, Russel C Huang
Vishal Hegde, Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, United States
Dennis S Meredith, Russel C Huang, Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical Center, New York, NY 10021, United States
Christopher K Kepler, Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Hegde V, Meredith DS, Kepler CK and Huang RC contributed to this paper.
Correspondence to: Vishal Hegde, Research Fellow, Department of Orthopedic Surgery, Weill Cornell Medical College, 420 East 70th Street Apt No. 5K-2, New York, NY 10021, United States.
Telephone: +1-212-6061172 Fax:+1-212-7721061
Received: April 3, 2012
Revised: October 21, 2012
Accepted: November 1, 2012
Published online: November 18, 2012

Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique, prophylactic antibiotics, avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinal instrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure.

Keywords: Surgical site infection, Spine surgery, Discitis, Postoperative infection