Central nervous system infection after thoracolumbar spinal laminectomy and decompression surgery and risk factors analysis

English Keywords:Central nervous system infection  Thoracolumbar spinal surgery  Risk factor

English Abstract:

  【Abstract】 Objectives: To analyze the central nervous system infection(CNSI) after thoracolumbar spinal laminectomy and decompression surgery and its risk factors. Methods: From June 2015 to Sep 2018, we retrospectively reviewed 2,632 patients underwent thoracolumbar spinal laminectomy and decompression surgery. 8 patients (5 males, 3 females) were diagnosed of postoperative CNSI according to the clinical features and cerebrospinal fluid (CSF) analysis, and the average age was 55.8±9.3(41-69) years old. 8 patients had fever, 7 had headache, 7 had neck stiffness and 4 had consciousness disturbance. The white blood cell count, C-reactive protein and erythrocyte sedimentation rate increased in all patients except one patient whose white blood cell count was normal. The CSF study demonstrated elevated white blood cell count, glucose decrease and protein increase in all patients. Bacterial cultures of all patients were negative except one patient with positive blood and CSF cultures. There was no abnormality in encephalo CT in 8 patients. One thoracic MRI showed deep incision infection and one lumbar MRI showed abnormal T2WI high signal of intradural cerebrospinal fluid. The treatment and follow-up results of 8 patients were recorded. Patients were divided into 2 groups according to whether postoperative CNSI occurred or not. Preoperative diagnosis, operation time, intraoperative bleeding, surgical segment, time of drainage removal, dural tear(DT) and surgical site infection(SSI) were recorded, and the Chi-square test was used to analyze the statistic differences between the 2 groups. Results: All 8 patients received 18.50±3.07(14-24) days of antibiotic treatment, except 1 patient who accepted debridement. All patients showed symptoms and signs disappeared completely, blood routine test, C-reactive protein and erythrocyte sedimentation rate normal before being discharged from hospital. The average follow-up was 20.50±8.19 months(12-36 months), and there was no fever, headache, neck resistance or consciousness disturbance; Blood routine, C-reactive protein and erythrocyte sedimentation rate were normal at the last follow-up. Chi square test showed that there were significant differences between the two groups in surgical segment and DT (P<0.05), while there were no significant differences in other factors(P>0.05). Conclusions: Postoperative CNSI is a rare complication after thoracolumbar spinal surgery. A highly suspicion should be maintained in patients with the clinical manifestations of fever, headache, neck stiffness and consciousness disturbance. Lumbar puncture and CSF study are necessary for suspicious patients. An early diagnosis and appropriate antibiotic treatment can lead to a good outcome. Surgical segment≥3 and DT were significantly correlated with CNSI.