Deep Wound Infection after Lumbar Spine Fusion with Pedicular Screw Fixation

Kim, Eung Ha; Song, In Soo

Abstract

STUDY DESIGN: Retrospective.
OBJECTIVE
To define the preoperative risk factors for postoperative deep wound infection of instrumented spine and to analyze treatment modality and its result. SUMMARY OF LITERATURE REVIEW: When there have been postoperative deep wound infection after pedicular screw fixation of lumbar spine. there have been controversies, which was appropriate time of implants removal.
MATERIALS AND METHODS
From January 1991 to December 1997, we performed 582 cases of posterior instrumentation using pedicular screws. We reviewed retrospectively seven cases who had suffered from postoperative wound infection in our hospital, and three referral cases from other hospitals.
RESULTS
Six of ten cases have been exposed significant preoperative risk factors(i. e., diabetes, old age, malnutrition, concomitant infection, obesity, etc.). Infections was diagnosed at an average of 12.3 days after operation with fever & wound drainage as the most common presenting feature. Patients underwent prompt incision & drainage, susceptible antibiotics, multiple debride-ments(average: 1.77, range: 1-3). Seven of ten cases underwent removal of implant finally. At follow up evaluation, all cases except one had no recurrence of infection. But five cases showed pseudarthrosis. Four (80%) of them underwent removal of implant within 1 year after operation. Clinical results by criteria of Kirkaldy-Willis were 2 Good's, 7 Fair's and 1 Poor.
CONCLUSION
Postoperative deep wound infection after pedicular screw fixation of lumbar spine leads to poor result. Especially early removal of implant within 1 year after operation was followed by pseudarthosis.