The following is a summary of “Surgical Site Infection After Posterior Stabilization of the Spine – When do we Have to Remove the Implants?,” published in the May 2023 issue of Spinal Disorders and Techniques by Prost et al.
The design of the study was retrospective data analysis. The primary purpose of this study was to determine if the treatment of Postoperative surgical site infections (PSSI) after posterior stabilization of the spine (PS) without radiological signs of screw loosening (RSL) has a reasonable success rate without implant removal and if there is a difference between early and late PSSI. If a loosening of one or more screws is detected, PSSI following PS is typically treated with implant removal and reinstrumentation. There is no conclusive data regarding the success rate of treating PSSI without implant removal in cases where no RSL is perceived.
All patients treated for a PSSI after PS without RSL at a single spine center between 12/2009 and 03/2020 were enrolled in a retrospective analysis. Revision surgery with debridement and irrigation, followed by antibiotic therapy, was used to treat patients. The implant was removed if the initial treatment did not improve wound healing and normalization of laboratory values. Statistical Package for the Social Sciences 25 was utilized to conduct statistical analysis. The descriptive data are presented as the mean and standard error of the mean, and a χ2 test was performed. About 17 of the 32 enrolled patients had an early PSSI, while 15 had a late PSSI. In 71.9% (23/32) of instances, the PSSI has been treated without implant removal: 12/17 examples of early PSSI and 11/15 cases of late PSSI.
The difference was not statistically significant (P > 0.05). One patient passed away, while the remaining patients were discharged from the hospital with no remaining laboratory indications of the infection and with closed soft tissues. The efficacy rate of irrigation and debridement without implant removal was 71.9% in their patient population. In light of these findings, conducting at least two irrigations and debridement before implant removal is a valid treatment option for PSSI after PS in the absence of RSL in both early and late PSSI.