The treatment of delayed infection following posterior instrumented spinal surgery

English Keywords:Posterior spinal operation  Delayed infection  Intervertebral space infection

English Abstract:

  【Abstract】 Objectives: To investigate the treatment of delayed infection(first onset time more than 1 month) following posterior instrumented spinal surgery. Methods: From August 2005 to December 2013, 18 cases with delayed infection following posterior instrumented spinal surgery were treated, including posterior cervical laminoplasty in 1 case and posterior lumbar decompression and fusion in 17 cases. There were 9 cases with delayed deep incision infection(group 1), 7 cases with delayed intervertebral space infection(group 2), 2 cases with both delayed deep incision and intervertebral space infection(group 3). The characteristics of delayed infection were analysed, the temperature, inflammation index(WBC, ESR, CRP), clinical manifestation among these 3 groups were compared, and the corresponding treatment were performed. Results: The average onset time of delayed infection was 17 months postoperatively(1-101 months). There was no significant difference in the onset time, temperature, WBC, ESR, CRP among 3 groups(P＞0.05), except for the temperature between group 2 and group 3(P＜0.05). In group 1, 8 cases underwent reoperation(debridement, washing and drainage), among whom 4 cases received instrument removal. In group 2, just 1 case with local instability was treated by reoperation, while 1 case with obvious deep infection was treated by reoperation in group 3. The other cases were treated with antibiotics only. All the cases were cured and followed up for an average of 18 months(12-40 months) with no recurrence of infection. Conclusions: Surgery (debridement, washing and drainage) is effective for the delayed deep incision infection. It is recommended to remove internal fixation for the cases with solid segmental fusion. Conservative treatment with antibiotics is the preferred choice for simple delayed intervertebral space infection, but surgery is still feasible while the patient is complicated with obvious incision deep infection or instability.