Implant-Associated Infection of Long-Segment Spinal Instrumentation: A Retrospective Analysis of 46 Consecutive Patients

Study Design This single-center retrospective study analyzed patients with an implant-associated infection of spinal instrumentation (four or more segments) treated between 2010 and 2018. Purpose This study aimed to investigate the treatment of implant-associated infections of long-segment spinal instrumentation and to define risk factors for implant removal. Overview of Literature Implant-associated infection occurs in 0.7%–20% of spinal instrumentation. Significant blood loss, delayed reoperation, and use of effective antibiotics are reported risk factors for implant removal. Methods Patients with superficial infections not involving the implant were excluded. All patients received surgical and antibiotic treatments according to our interdisciplinary osteomyelitis board protocol. An infection was considered healed if a patient showed no signs of infection 1 year after termination of treatment. The patients were divided into an implant retention group and implant removal group, and their clinical and microbiological data were compared. Results Forty-six patients (27 women, 19 men) with an implant-associated infection of long-segment spinal instrumentation and mean age of 65.3±14.3 years (range, 22–89 years) were included. The mean length of the infected instrumentation was 6.5±2.4 segments (range, 4–13 segments). Implant retention was possible in 21 patients (45.7%); in the other 25 patients (54.3%), a part of or the entire implant required removal. Late infections were associated with implant removal, which correlated with longer hospitalization. Both groups showed high postoperative complication rates (50%) and high mortality rates (8.7%). In 39 patients (84.8%), infection was eradicated at a mean follow-up of 18.9±11.1 months (range, 12–60 months). Three patients (6.5%) were lost to follow-up. Conclusions Implant-associated infections of long-segment spinal instrumentations are associated with high complication and mortality rates. Late infections are associated with implant removal. Treatment should be interdisciplinary including orthopedic surgeons and clinical infectiologists.

[1]  B. W. Schreurs,et al.  Clinical Outcome of Antibiotic Suppressive Therapy in Patients with a Prosthetic Joint Infection after Hip Replacement , 2019, Journal of bone and joint infection.

[2]  S. Matsuda,et al.  Risk factors for implant removal after spinal surgical site infection , 2018, European Spine Journal.

[3]  N. Hickok.  What Are Biofilms? , 2018, Spine.

[4]  David S. Casper,et al.  The Effect of Postoperative Spinal Infections on Patient Mortality , 2018, Spine.

[5]  Jiaming Liu,et al.  Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery , 2017, Spine.

[6]  D. Skaggs,et al.  Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse , 2016, Spine deformity.

[7]  N. Dahdaleh,et al.  Evidence-based management of deep wound infection after spinal instrumentation , 2015, Journal of Clinical Neuroscience.

[8]  Lee A. Tan,et al.  Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management , 2013, Surgical neurology international.

[9]  F. Pellisé,et al.  Implant survival after deep infection of an instrumented spinal fusion. , 2013, The bone & joint journal.

[10]  Seong-Jang Kim,et al.  Implant Removal for the Management of Infection After Instrumented Spinal Fusion , 2010, Journal of spinal disorders & techniques.

[11]  T. Hresko,et al.  Failure of Attempted Implant Retention in Spinal Deformity Delayed Surgical Site Infections , 2009, Spine.

[12]  J. Weiss,et al.  Management of Infection After Instrumented Posterior Spine Fusion in Pediatric Scoliosis , 2007, Spine.

[13]  J. Mandrekar,et al.  The management and outcome of spinal implant infections: contemporary retrospective cohort study. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  Serena S. Hu,et al.  Risk Factors for Infection After Spinal Surgery , 2005, Spine.

[15]  D. Schlenzka,et al.  Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases , 2004, European Spine Journal.

[16]  R. Darouiche.  Antimicrobial approaches for preventing infections associated with surgical implants. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  J. Costerton,et al.  Bacterial biofilms: a common cause of persistent infections. , 1999, Science.

[18]  Teresa C. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999 , 1999, Infection Control & Hospital Epidemiology.

[19]  H. King,et al.  Delayed Infection After Elective Spinal Instrumentation and Fusion: A Retrospective Analysis of Eight Cases , 1997, Spine.

[20]  S. Garfin.  Point of View: Delayed Infection After Elective Spinal Instrumentation and Fusion: A Retrospective Analysis of Eight Cases , 1997 .

[21]  B. S. Richards,et al.  Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. , 1995, The Journal of bone and joint surgery. American volume.

[22]  T. Witham,et al.  Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. , 2014, Journal of neurosurgery. Spine.

[23]  T. Horan,et al.  Guideline for prevention of surgical site infection. , 2000, Bulletin of the American College of Surgeons.

[24]  F. Seral,et al.  Adherence of Staphylococcus aureus slime-producing strain variants to biomaterials used in orthopaedic surgery , 1997, International Orthopaedics.

[25]  D. Garland,et al.  Cost of medical care for postoperative spinal infections. , 1996, The Orthopedic clinics of North America.

[26]  Recommendations for preventing the spread of vancomycin resistance. Hospital Infection Control Practices Advisory Committee. , 1995, Emerging infectious diseases.