Prognosis of deep infection in spinal surgery using implants, treated by retention, removal of bone graft and lengthy antibiotherapy

Study Design: A retrospective case-controlled study. Objectives: To evaluate overall infection rate and adverse event after harvesting bone graft soaking and surgical wound irrigation by povidone iodine solution (PVI) in the minimally invasive instrumented spinal fusion surgery. In order to reduce the rate of surgical site infection in spinal surgery, surgical wound irrigation by povidone iodine solution has been well-established. However, the efficacy of autologous bone graft soaking by PVI has not been evaluated before. Methods: This is a retrospective cohort study. 120 patients were enrolled in the PVI group and compared with 124 patients in the historical cohort. In the PVI group, the harvesting autologous bone graft was soaking and the surgical wound was also irrigated by diluted PVI solution. The outcome measures were overall infection rate, superficial wound infection and deep infection. In addition, the delayed union of the fusion mass was also evaluated through the radiograph evaluation. Results: Both groups shared similar patient demographics instead of body mass index. The use of PVI solution had decreased the overall infection rate (0% versus 4.03%, p = 0.026) and deep infection rate (0% versus 3.23%, p = 0.047). In addition, there was no delayed bone healing in the PVI group after autologous bone graft soaking. Conclusions: In this study, we conclude that harvested autologous bone graft after PVI soaking in spinal fusion surgery can decrease the incidence of deep infection.

Download Full-text

A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation

BMJ Case Reports ◽

10.1136/bcr-2017-220792 ◽

2017 ◽

pp. bcr-2017-220792 ◽

Cited By ~ 3

Author(s):

Mauro Dobran ◽

Fabrizio Mancini ◽

Davide Nasi ◽

Massimo Scerrati

Keyword(s):

Spinal Surgery ◽

Deep Infection ◽

Dorsal Spinal

Download Full-text

Multiple recurrent postoperative spinal infections due to an unrecognized presacral abscess following placement of bicortical sacral screws: case report

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine141059 ◽

2016 ◽

Vol 24 (3) ◽

pp. 502-505

Author(s):

Laura Bloom ◽

S. Shelby Burks ◽

Allan D. Levi

Keyword(s):

Spinal Surgery ◽

Deep Infection ◽

Wound Infections ◽

Lumbar Surgery ◽

Pedicle Screw Placement ◽

Postoperative Wound ◽

Important Complication ◽

Intravenous Antibiotics ◽

Presacral Abscess ◽

Spinal Infections

Postoperative wound infections in spinal surgery remain an important complication to diagnose and treat successfully. In most cases of deep infection, even with instrumentation, aggressive soft-tissue debridement followed by intravenous antibiotics is sufficient. This report presents a patient who underwent L3–S1 laminectomy and pedicle screw placement including bicortical sacral screws. This patient went on to develop multiple (7) recurrent infections at the operative site over a 5-year period. Continued investigation eventually revealed a large presacral abscess, which remained the source of recurrent bacterial seeding via the remaining bone tracts of the bicortical sacral screws placed during the original lumbar surgery. Two years after drainage of this presacral collection via a retroperitoneal approach, the patient remains symptom free.

Download Full-text

ISASS Recommendations and Coverage Criteria for Bone Graft Substitutes used in Spinal Surgery

The International Journal of Spine Surgery ◽

10.14444/5095 ◽

2018 ◽

Vol 12 (6) ◽

pp. 757-771

Author(s):

CELESTE ABJORNSON ◽

ANTONIO BRECEVICH ◽

TUCKER CALLANAN ◽

CHRISTINA DOWE ◽

FRANK P. CAMMISA ◽

...

Keyword(s):

Bone Graft ◽

Spinal Surgery ◽

Coverage Criteria ◽

Bone Graft Substitutes

Download Full-text

Complications of Bone Graft Harvest, Allograft Bone, and Bone Graft Extenders or Alternatives in Spinal Surgery

Complications of Pediatric and Adult Spinal Surgery ◽

10.1201/b14827-6 ◽

2004 ◽

pp. 37-50

Keyword(s):

Bone Graft ◽

Spinal Surgery ◽

Allograft Bone ◽

Graft Harvest

Download Full-text

SEMI-CONSTRAINED TOTAL ELBOW ARTHROPLASTY IN CHINESE RHEUMATOID PATIENTS

Hand Surgery ◽

10.1142/s0218810403001649 ◽

2003 ◽

Vol 08 (02) ◽

pp. 187-192 ◽

Cited By ~ 8

Author(s):

C. Y. Lo ◽

K. B. Lee ◽

C. K. Wong ◽

Y. P. Chang

Keyword(s):

Bone Graft ◽

Deep Infection ◽

Total Elbow Arthroplasty ◽

Radiological Sign ◽

Performance Score ◽

Early Complications ◽

Mayo Elbow Performance Score ◽

Elbow Arthroplasty

Seventeen Coonrad-Morrey semi-constrained total elbow replacements were performed on 14 Chinese rheumatoid patients. The elbows were reviewed retrospectively after a mean follow-up of 36 months (range 12–89 months.) After the operation, all patients were satisfied and there was no pain in 15 elbows. There was no radiological sign of loosening in the implanted prostheses and bone graft was incorporated in 93% of primary elbow replacements. The Mayo Elbow Performance Score was improved from an average of 40 (range 20–75) to an average of 93 (range 65–100). The arc of flexion was improved from an average of 89° (range 0°–125°) to 104° (range 35°–125°). The sizes of implants can be predicted accurately by the planning template in only four elbows (24%) and there were early complications in seven elbows (41%), with one prosthesis removed because of deep infection.

Download Full-text

Result of Arthrodesis of the Hallux Metatarsophalangeal Joint Using Bone Graft for Restoration of Length

Foot & Ankle International ◽

10.1177/107110070002100405 ◽

2000 ◽

Vol 21 (4) ◽

pp. 297-306 ◽

Cited By ~ 109

Author(s):

Mark S. Myerson ◽

Lew C. Schon ◽

Francis X. McGuigan ◽

Ali Oznur

Keyword(s):

Bone Loss ◽

Bone Graft ◽

Total Joint Replacement ◽

Metatarsophalangeal Joint ◽

Technical Difficulty ◽

Deep Infection ◽

High Rate ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

First Ray

We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal metatarsal osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first metatarsal, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser metatarsal osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

Download Full-text