J Korean Soc Spine Surg.  2001 Dec;8(4):504-512.

Management of Deep Infection after Posterior Spinal Instrumentation with Prolonged Suction Drainage

• Kim YM
• Won CH
• Choi ES
• Seo JB
• Lee HS
• Cho BK

Abstract

STUDY DESIGN: A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation.
OBJECTIVES
Analysis of the inherent risk factors associated with deep infection and the efficacy of management with prolonged suction drainage without removal of implants. SUMMARY OF LITERATURE REVIEW: Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still controversial because it may cause loss of spinal stability.
MATERIALS AND METHODS
Five cases of postoperative deep infection after posterior spinal fixation from May 1996 to May 2000 were investigated about combined general illness, features of infection, various profiles on management of the infection with surgical irrigation and debridement followed by prolonged suction drainage, and final outcomes.
RESULTS
Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, fever were observed since average 18.8th day postoperatively. By only one surgical procedure for each patient followed by prolonged suction drainage for mean 19.2 days and administration of IV antibiotics for average 43.6 days followed by oral antibiotics for 33.8 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion.
CONCLUSION
Irrigation and debridement accompanied by prolonged suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods in controlling deep infection after posterior instrumentation and in maintaining the postoperative stability of spine.

Keyword

Deep infection; Posterior spinal instrumentation; Prolonged suction drainage

MeSH Terms

Anti-Bacterial Agents
Debridement
Fever
Humans
Obesity
Retrospective Studies
Risk Factors
Spine
Suction*
Wounds and Injuries
Anti-Bacterial Agents

Figure

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  Fig. 1. Diagram showing patterns of daily drainage amount via Hemovac.

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  Fig. 2-A. T2 sagittal MR image shows spondylolisthesis of L3-4, L5-S1 and multilevel stenosis in a 58 year-old lady with Diabetes and obesity. Fig. 2-B. Posterior decompression and posterolateral fusion with transpedicular screw system including transverse fixation were performed.

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  Fig. 3. Wound dehiscence with discharge was observed since postoperative 11th day.

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  Fig. 4-A. On 14th day, the wound was reopened for thorough irrigation and debridement. TLC bar was removed to minimize dead space. Two pairs of Hemovac were inserted for drainage. Fig. 4-B. Postoperative lateral X-ray.

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  Fig. 5. Anteroposterior X-ray at postoperative 6 month shows bridging of posterolateral fusion mass.

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