A Biofilm-Based Approach to the Diagnosis and Management of Postoperative Spine Infection

2019 ◽  
pp. 107-130
Author(s):  
Jeremy D. Shaw
Keyword(s):  
Spine Infection ◽  
Diagnosis And Management ◽  
Postoperative Spine

scholarly journals Postoperative Spine Infection: Diagnosis and Management

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 37S-43S ◽  
Author(s):  
James Dowdell ◽  
Robert Brochin ◽  
Jun Kim ◽  
Samuel Overley ◽  
Jonathan Oren ◽  
...  
Keyword(s):  
Medical Subject Headings ◽  
Spine Infection ◽  
Diagnosis And Management ◽  
Reactive Protein ◽  
Mesh Terms ◽  
Deep Wound ◽  
Cochrane Database ◽  
Postoperative Spine ◽  
High Index Of Suspicion ◽  
Monitoring Treatment

Study Design: Review article. Objectives: A review of the literature on postoperative spinal infections, their diagnosis, and management. Methods: A systematic computerized Medline literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The electronic databases were searched for publication dates from the last 10 years. The searches were performed from Medical Subject Headings (MeSH) used by the National Library of Medicine. Specifically, MeSH terms “spine,” “infections,” “management,” and “diagnosis” were used. Results: Currently, the gold standard for diagnosis of postoperative spine infection is positive deep wound culture. Many of the current radiologic and laboratory tests can assist with the initial diagnosis and monitoring treatment response. Currently erythrocyte sedimentation rate, C-reactive protein, computed tomography scan, and magnetic resonance imaging with and without contrast are used in combination to establish diagnosis. Management of postoperative spine infection involves thorough surgical debridement and targeted antibiotic therapy. Conclusions: Postoperative spine infection is a not uncommon complication following surgery that may have devastating consequences for a patient’s short- and long-term health. A high index of suspicion is needed to make an early diagnosis.

scholarly journals Vancomycin microspheres reduce postoperative spine infection in an in vivo rabbit model

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Gang Liu ◽  
Si Chen ◽  
Jun Fang ◽  
Baoshan Xu ◽  
Shuang Li ◽  
...  
Keyword(s):  
Rabbit Model ◽  
Spine Infection ◽  
Postoperative Spine

scholarly journals Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications

2021 ◽  
Vol 2021 ◽  
pp. 1-20
Author(s):  
Roberto Corona-Cedillo ◽  
Melanie-Tessa Saavedra-Navarrete ◽  
Juan-Jose Espinoza-Garcia ◽  
Alexela-Nerey Mendoza-Aguilar ◽  
Sergey K. Ternovoy ◽  
...  
Keyword(s):  
Healing Process ◽  
Diagnostic Techniques ◽  
Adjacent Segment ◽  
Nuclear Medicine Imaging ◽  
Spine Infection ◽  
Advantages And Disadvantages ◽  
Surgical Implants ◽  
Pictorial Review ◽  
Spine Imaging ◽  
Postoperative Spine

Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.

Propionibacterium acnes causing delayed postoperative spine infection: Review

2010 ◽  
Vol 42 (6-7) ◽  
pp. 405-411 ◽  
Author(s):  
Rachid Haidar ◽  
Marc Najjar ◽  
Asdghig Der Boghossian ◽  
Zuhair Tabbarah
Keyword(s):  
Propionibacterium Acnes ◽  
Spine Infection ◽  
Postoperative Spine

scholarly journals Current Animal Models of Postoperative Spine Infection and Potential Future Advances

2015 ◽  
Vol 2 ◽  
Author(s):  
A. I. Stavrakis ◽  
A. H. Loftin ◽  
E. L. Lord ◽  
Y. Hu ◽  
J. E. Manegold ◽  
...  
Keyword(s):  
Animal Models ◽  
Spine Infection ◽  
Postoperative Spine

Deep postoperative spine infection treated by negative pressure therapy in patients with progressive spinal deformities

2017 ◽  
Vol 138 (4) ◽  
pp. 463-469 ◽  
Author(s):  
Federico Canavese ◽  
Lorenza Marengo ◽  
Marco Corradin ◽  
Mounira Mansour ◽  
Antoine Samba ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Spinal Deformities ◽  
Negative Pressure Therapy ◽  
Spine Infection ◽  
Pressure Therapy ◽  
Postoperative Spine

Imaging and Management of Postoperative Spine Infection

2014 ◽  
Vol 24 (2) ◽  
pp. 365-374 ◽  
Author(s):  
Joseph P. Mazzie ◽  
Michael K. Brooks ◽  
Jeffrey Gnerre
Keyword(s):  
Spine Infection ◽  
Postoperative Spine

Removal of instrumentation for postoperative spine infection: systematic review

2021 ◽  
pp. 1-13
Author(s):  
Andrew Hersh ◽  
Robert Young ◽  
Zach Pennington ◽  
Jeff Ehresman ◽  
Andy Ding ◽  
...  
Keyword(s):  
Biofilm Formation ◽  
Web Of Science ◽  
Outcome Data ◽  
Cochrane Library ◽  
Infected Wound ◽  
Spine Infection ◽  
Wound Debridement ◽  
Loss Of Correction ◽  
Quality Retention ◽  
Postoperative Spine

OBJECTIVE Currently, no consensus exists as to whether patients who develop infection of the surgical site after undergoing instrumented fusion should have their implants removed at the time of wound debridement. Instrumentation removal may eliminate a potential infection nidus, but removal may also destabilize the patient’s spine. The authors sought to summarize the existing evidence by systematically reviewing published studies that compare outcomes between patients undergoing wound washout and instrumentation removal with outcomes of patients undergoing wound washout alone. The primary objectives were to determine 1) whether instrumentation removal from an infected wound facilitates infection clearance and lowers morbidity, and 2) whether the chronicity of the underlying infection affects the decision to remove instrumentation. METHODS PRISMA guidelines were used to review the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov databases to identify studies that compared patients with implants removed and patients with implants retained. Outcomes of interest included mortality, rate of repeat wound washout, and loss of correction. RESULTS Fifteen articles were included. Of 878 patients examined in these studies, 292 (33%) had instrumentation removed. Patient populations were highly heterogeneous, and outcome data were limited. Available data suggested that rates of reoperation, pseudarthrosis, and death were higher in patients who underwent instrumentation removal at the time of initial washout. Three studies recommended that instrumentation be uniformly removed at the time of wound washout. Five studies favored retaining the original instrumentation. Six studies favored retention in early infections but removal in late infections. CONCLUSIONS The data on this topic remain heterogeneous and low in quality. Retention may be preferred in the setting of early infection, when the risk of underlying spine instability is still high and the risk of mature biofilm formation on the implants is low. However, late infections likely favor instrumentation removal. Higher-quality evidence from large, multicenter, prospective studies is needed to reach generalizable conclusions capable of guiding clinical practice.

scholarly journals Comparison of MRI, [18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis—a prospective multicenter study

2020 ◽  
Author(s):  
Diana Paez ◽  
Mike M. Sathekge ◽  
Hassan Douis ◽  
Francesco Giammarile ◽  
Shazia Fatima ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Roc Curve ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Imaging Modalities ◽  
Prospective Multicenter Study ◽  
Spine Infection ◽  
Pet Ct ◽  
Postoperative Spine ◽  
Fdg Pet Ct

Abstract Purpose Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study.

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