TY - JOUR
T1 - Instrumented fusion in the setting of primary spinal infection
AU - Delagarza-Ramos, Rafael
AU - Bydon, Mohamad
AU - Macki, Mohamed
AU - Abt, Nicholas B.
AU - Rhee, Jay
AU - Gokaslan, Ziya L.
AU - Bydon, Ali
N1 - Publisher Copyright:
© 2015 Edizioni Minerva Medica.
PY - 2017/2
Y1 - 2017/2
N2 - INTRODUCTION: The objective of this study is to investigate the morbidity and mortality associated with instrumented fusion in the setting of primary spinal infection. EVIDENCEACQUISITION: Asearch was performed in the PubMed and Medline databases for clinical case series describing instrumented fusion in the setting of primary spinal infection between 2003 and 2013. The search was limited to the English language and case series including at least 20 patients. The primary outcome measure was postoperative infection (recurrent local infection) + surgical site infection (SSI); secondary outcome measures included reoperation rates, development of other complications, and perioperative mortality. EVIDENCESYNTHESIS: There were 26 publications that met the inclusion criteria, representing 931 patients with spondylodiscitis who underwent decompression, debridement, and instrumented fusion. Spinal infections occurred most commonly in the lumbosacral spine (39.1%) followed by the thoracic spine (27.1%). The most common microorganisms were Staphylococcus spp. After decompression, debridement, and instrumented fusion, the overall rate of postoperative infection was 6.3% (1.6% recurrent infection rate + 4.7% SSIrate). The perioperative complication rate was 15.4%, and the mortality rate was estimated at 2.3%. Reoperation for wound debridement, instrumentation removal, pseudoarthrosis, and/or progressive neurological deficit was performed in 4.5% of patients. CONCLUSIONS: The findings in this literature review suggest that the addition of instrumentation in the setting of a primary spinal infection has a low local recurrent infection rate (1.6%). However, the combined risk of postoperative infection is 6.3% (recurrent infection + SSI), more than three-fold the current infection rate following instrumentation procedures for degenerative spine disease. Moreover, the addition of hardware does usher in complications such as instrumentation failure and pseudoarthrosis requiring reoperation.
AB - INTRODUCTION: The objective of this study is to investigate the morbidity and mortality associated with instrumented fusion in the setting of primary spinal infection. EVIDENCEACQUISITION: Asearch was performed in the PubMed and Medline databases for clinical case series describing instrumented fusion in the setting of primary spinal infection between 2003 and 2013. The search was limited to the English language and case series including at least 20 patients. The primary outcome measure was postoperative infection (recurrent local infection) + surgical site infection (SSI); secondary outcome measures included reoperation rates, development of other complications, and perioperative mortality. EVIDENCESYNTHESIS: There were 26 publications that met the inclusion criteria, representing 931 patients with spondylodiscitis who underwent decompression, debridement, and instrumented fusion. Spinal infections occurred most commonly in the lumbosacral spine (39.1%) followed by the thoracic spine (27.1%). The most common microorganisms were Staphylococcus spp. After decompression, debridement, and instrumented fusion, the overall rate of postoperative infection was 6.3% (1.6% recurrent infection rate + 4.7% SSIrate). The perioperative complication rate was 15.4%, and the mortality rate was estimated at 2.3%. Reoperation for wound debridement, instrumentation removal, pseudoarthrosis, and/or progressive neurological deficit was performed in 4.5% of patients. CONCLUSIONS: The findings in this literature review suggest that the addition of instrumentation in the setting of a primary spinal infection has a low local recurrent infection rate (1.6%). However, the combined risk of postoperative infection is 6.3% (recurrent infection + SSI), more than three-fold the current infection rate following instrumentation procedures for degenerative spine disease. Moreover, the addition of hardware does usher in complications such as instrumentation failure and pseudoarthrosis requiring reoperation.
KW - Central nervous system infections
KW - Discitis
KW - Neurosurgical procedures
KW - Osteomyelitis
KW - Spinal fusion
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M3 - Review article
C2 - 25875732
AN - SCOPUS:85014434113
SN - 0390-5616
VL - 61
SP - 64
EP - 76
JO - Journal of neurosurgical sciences
JF - Journal of neurosurgical sciences
IS - 1
ER -