Impact of surgical site infection and surgical debridement on lumbar arthrodesis: A single-institution analysis of incidence and risk factors |
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| Institution: | 1. Department of Radiology, The Royal Melbourne Hospital, Parkville, VIC, Australia;2. Department of Radiology, The University of Melbourne, Parkville, VIC, Australia;3. Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia;4. Monash Imaging, Monash Health, Clayton, VIC, Australia;1. New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand;2. University of Otago, Christchurch, New Zealand;3. Menzies Research Institute, University of Tasmania, Hobart, Australia;4. Queen Square MS Centre, UCL Institute of Neurology, London, UK;5. School of Health Sciences, University of Canterbury, Christchurch, New Zealand;6. Auckland District Health Board, Auckland, New Zealand;7. University of Otago, Wellington, New Zealand;8. School of Geographical Sciences, University of Bristol, Bristol, UK;9. Christchurch Public Hospital, Christchurch, New Zealand;1. Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, 1 Children’s Way, Little Rock, AR 72202, USA;2. Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;3. Division of Neurosurgery, Arkansas Children’s Hospital, and Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA;1. Cerebrovascular Laboratory, Department of Neurosurgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA;2. Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, MA, USA;3. Neuro-Intensive Care Unit, Columbia University Medical Center, New York, NY, USA |
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| Abstract: | This study identifies the rate of pseudarthrosis following surgical debridement for deep lumbar spine surgical site infection and identify associated risk factors. Patients who underwent index lumbar fusion surgery from 2013 to 2014 were included if they met the following criteria: 1) age >18 years, 2) had debridement of deep lumbar SSI, and had 3) lumbar spine AP, lateral and flexion/extension X-rays and computed tomography (CT) at 12 months or greater postoperatively. Criteria for fusion included 1) solid posterolateral, facet, or disk space bridging bone, 2) no translational or angular motion on flexion/extension X-rays, and 3) intact posterior hardware without evidence of screw lucency or breakage. Twenty-five patients (age 63.2 ± 12.6 years, 10 male) involving 58 spinal levels met inclusion criteria. They underwent fusion at a mean of 2.32 range 1–4] spinal levels. Sixteen (64.0%) patients received interbody grafts at a total of 34 (58.6%) spinal levels. All underwent surgical debridement with removal of all non-incorporated posterior bone graft and devascularized tissue. At one-year postoperatively, (56%) patients and 30 (52%) spinal levels demonstrated radiographic evidence of successful fusion. Interbody cage during initial fusion was significantly associated with successful arthrodesis at follow-up (p = 0.017). There is a high rate of pseudoarthrosis in 44% of patients (48% of levels) undergoing lumbar fusion surgery complicated by SSI requiring debridement. Use of interbody cage during initial fusion was significantly associated with higher rate of arthrodesis. |
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| Keywords: | Surgical site infection Lumbar spine Pseudoarthrosis Fusion Irrigation and debridement Interbody cage |
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