Management and outcome of spinal implant-associated surgical site infections in patients with posterior instrumentation: analysis of 176 cases

Abstract Background: Adjacent segment disease (ASD) is a major complication following spinal instrumentation and fusion. The search for of the rod flexibility factors responsible for junctional degeneration is still ongoing. Objective: Determine the rod stiffness and ASD following posterior instrumentation and fusion for lumbar spine and find the proper rod diameter for adult spinal instrumentation for fusion. Subject and methods: Retrospective evaluation of all patients requiring spinal instrumentation to determine the different rod diameter that predispose toward junctional degeneration was completed. All patients requiring spinal instrumentation over a one-year period were studied retrospectively. One-hundred eight-seven patients (mean age 61.6 years) who had undergone decompression and fusion with pedicle screw instrumentation were evaluated. The average follow-up was 4.2 years. The average number of levels fused was 2.9 segments (range: 1-8). Adjacent spinal level pre- and post-operatively was determined on the plain X-rays. Junctional degeneration was defined as new episode of degeneration of the adjacent level on radiologic finding. Asymptomatic patients did not demonstrate junctional degeneration on the routine post-operative X-rays. Results: ASD developed in 15 (8.0%) out of 187 patients, including compression fractures (n=2), spinal stenosis (n=6), and symptomatic disc collapse (n=7). There was a close correlation between the posterior instrument stiffness and the development of ASD (p=0.011). For fusion and fixation with 5.5 mm and 6.0 mm rod diameter, ASD occurred in four (3.7%) out of 108 patients and in 11 (13.9 %) out of 79 patients, resepectively. The incidences of ASD were greater when the posterior instrument used were stiffer in lumbar spine fusion. The pre-operative age, gender, and indication for surgery were not associated with the development of ASD. Conclusion: The prevalence of symptomatic ASD relatively increased with increasing stiffness of spinal implant. The diameter of the longitudinal rod strongly affected the fixator loads, and influenced the stresses in the vertebral endplates. The rod diameter had influence on the stresses in the adjacent spinal motion segment.

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330 Surgical Site Infections in Standalone Lateral Interbody Fusion: Analysis of a Prospective, Multi-center Patient Outcomes Registry

Neurosurgery ◽

10.1093/neuros/nyx417.330 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 273-273

Author(s):

Gautam Madhu Nayar ◽

Timothy Y Wang ◽

Adam Gregory Back ◽

Kyle Malone ◽

Robert E Isaacs

Keyword(s):

Internal Fixation ◽

Interbody Fusion ◽

Posterior Instrumentation ◽

Surgical Site Infections ◽

Infection Rates ◽

Hospital Stays ◽

Supplemental Fixation ◽

Fusion Analysis ◽

Lumbar Spinal ◽

Lateral Interbody

Abstract INTRODUCTION Surgical site infections (SSI) following lumbar spinal fusion procedures are associated with extended hospital stays, increased complications, and lower patient outcome satisfaction. Additionally, hospitals can face stiff financial penalties from CMS for increased rates of SSI. Modern minimally invasive approaches for anterior interbody fusion (XLIF) were developed to minimize approach-related morbidity compared to direct anterior and conventional posterior approaches, the latter of which are associated with infection rates from 2.7% to as high as 10.9%. The aim of this study is to evaluate infection rates following XLIF in those patient with and without supplemental internal fixation. METHODS A total of 994 patients treated with XLIF from T12-L1 to L5-S1 (619 with supplemental internal fixation, 375 standalone) were evaluated and included in the analysis. On average, patients were treated at fewer levels in the standalone versus fixated group (mean 1.7 versus 2.1 levels). RESULTS >A total of nine (9) surgical site infections were reported in 994 XLIF patients (0.9%), with no significant differences between standalone and fixation (0.8% and 1% respectively, P = 1.00). The standalone group had two superficial infections, which only extended the post-operative length of stay. The supplemental fixation group had two infections from posterior instrumentation and three superficial infections, all of which only required longer hospitalization. Additionally, there were two deep wound infections, one in each cohort, that required I&D. No patients suffered long-term consequences. CONCLUSION Infections following XLIF were rare (<1%) in a relatively large, multi-centric experience and did not vary with use of supplemental fixation. Compared to previously reported outcomes in the anterior and posterior approach, XLIF is associated with decreased rates of infection, thereby reducing harm to the patient and cost to the hospital.

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Surgical site infections after minimally invasive versus open posterior instrumentation for patients with spinal metastases

Brain and Spine ◽

10.1016/j.bas.2021.100428 ◽

2021 ◽

Vol 1 ◽

pp. 100428

Author(s):

A.-K. Joerger ◽

N. Schwendinger ◽

N. Lange ◽

A. Wagner ◽

Y.-M. Ryang ◽

...

Keyword(s):

Minimally Invasive ◽

Posterior Instrumentation ◽

Spinal Metastases ◽

Surgical Site Infections

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Low Albumin, Reoperation Found to Raise Risk of Surgical Site Infections

Ob Gyn News ◽

10.1016/s0029-7437(08)70506-8 ◽

2008 ◽

Vol 43 (15) ◽

pp. 25

Author(s):

JEFF EVANS

Keyword(s):

Surgical Site Infections

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Feds May Stop Pay for Surgical Site Infections

Skin & Allergy News ◽

10.1016/s0037-6337(07)70289-9 ◽

2007 ◽

Vol 38 (4) ◽

pp. 57

Author(s):

BRUCE JANCIN

Keyword(s):

Surgical Site Infections

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Hospital Slashes Surgical Site Infections Using NSQIP

Hospitalist News ◽

10.1016/s1875-9122(11)70242-5 ◽

2011 ◽

Vol 4 (12) ◽

pp. 12

Author(s):

MARY ELLEN SCHNEIDER

Keyword(s):

Surgical Site Infections

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Risk factor analysis for surgical site infections in 750 vascular surgery patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1038080 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

O Teebken ◽

E Ott ◽

AM Pichlmaier ◽

I Chaberny ◽

P Gastmeier ◽

...

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Vascular Surgery ◽

Surgical Site Infections ◽

Risk Factor Analysis

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COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v2i6.38 ◽

2018 ◽

Author(s):

Anil Pandey ◽

Setul Shah ◽

Deepak S Maravi ◽

S Uikey

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Proximal Tibia ◽

Plate Fixation ◽

Surgical Site Infections ◽

Delayed Union ◽

Large Sample Size ◽

Multicentric Study ◽

Group A ◽

Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

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