Postoperative infection in patients undergoing posterior lumbosacral spinal surgery: A pictorial guide for diagnosis and early treatment

Shih Hao Chen, Wen Jer Chen, Meng Huang Wu, Jen Chung Liao, Chen Ju Fu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Surgical site infections after posterior spinal surgery may lead to spondylodiscitis, pseudarthrosis, correction loss, adverse neurological sequelae, sepsis, and poor outcomes if not treated immediately. Infection rates vary depending on the type and extent of operative procedures, use of instrumentation, and patients' risk factors. Image evaluation is crucial for early diagnosis and should be complementary to clinical routes, laboratory survey, and treatment timing. Magnetic resonance imaging detects early inflammatory infiltration into the vertebrae and soft tissues, including hyperemic changes of edematous marrow, vertebral endplate, and abscess or phlegmon accumulation around the intervertebral disk, epidural, and paravertebral spaces. Aggressive surgical treatment can eradicate infection sources, obtain a stable wound closure, decrease morbidity, and restore spinal integrity. Organ/space infection is defined as any body parts opened to manipulate other than superficial/deep incision. Advanced magnetic resonance imaging evaluating abnormal fluid accumulation, heterogenous contrast enhancement of the endplate erosion due to cage/screw infection is categorized to inform a presumptive diagnosis for early implant salvage. However, patients' defense response, infection severity, bacteriology, treatment timing, spinal stability, and available medical and surgical options must be fully considered. Revision surgery is indicated for pseudarthrosis, implant loosening with correction loss, recalcitrant spondylodiscitis, and adjacent segment diseases for infection control.

Original languageEnglish
Pages (from-to)225-238
Number of pages14
JournalClinical Spine Surgery
Volume31
Issue number6
DOIs
Publication statusPublished - Jul 1 2018

Keywords

  • instrumentation
  • posterior spinal surgery
  • spondylodiscitis
  • surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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