J Korean Soc Spine Surg.  2009 Dec;16(4):274-284. 10.4184/jkss.2009.16.4.274.

Precautions Against Infection Following Posterior Spinal Fusion Based on Types of Infection and Risk Factors

• Ahn DK
• Choi DJ
• Park HS
• Kim TW
• Chun TH
• Yang JH

• KMID: 1819809
• DOI: http://doi.org/10.4184/jkss.2009.16.4.274

Abstract

STUDY DESIGN: This is a retrospective preparative study and prospective study
OBJECTIVE
We instituted and verified the precautions against postoperative spinal infection. SUMMARY OF THE LITERATURE REVIEW: Postoperative infection comes from contamination during the operation and various strategies have been recommended to prevent it.
MATERIALS AND METHODS
583 cases that underwent instrumented posterior spinal fusion during two years (group I), were reviewed to discover the risk factors, and intraoperative cultures were done to detect the contamination routes and the causative microorganisms for the next 4 months. Six precautions, based on the results, were instituted. We analyzed 354 cases that underwent operation in the following year (group II) using the precautions.
RESULTS
Twenty cases (3.4%) were infected in group I and the types of infection were superficial wound infection (4 cases), deep wound infection (4 cases), osteomyelitis around the interbody space (7 cases), osteomyelitis around the pedicle screws (4 cases) and a combination of wound infection and osteomyelitis around the pedicle screws (1 case). Infections happened more frequently in the cases of interbody fusion (p=0.034), revision (p=0.087) and those done in the summer season (p=0.025). S. epidermidis, as the causative bacteria, was cultured from both the operation environments and wounds. Six precautions based on the preliminary results were instituted as follows; irrigation method reformation, delayed opening of instruments, turning-off local air conditioners, changing of gowns before instrumentation, local bone irrigation and limited indications for interbody fusion. After implementation, two cases (0.6%) of infection developed in group II (p=0.002, odds ratio=0.160; 95% confidence interval = 0.037 to 0.688).
CONCLUSION
Wounds, grafted bones or instruments can be contaminated under longer-time exposure to operating room air and so produce interbody or pedicle osteomyelitis without wound infection. The precautions were effective to decrease the postoperative infection rates following posterior spinal fusion.

Keyword

Spinal fusion; Routes of contamination; Prevention of infection

MeSH Terms

Bacteria
Operating Rooms
Osteomyelitis
Prospective Studies
Retrospective Studies
Risk Factors
Seasons
Spinal Fusion
Transplants
Wound Infection

Figure

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  Fig. 1. Osteomyleitis around interbody graft. (A, B) Blurring of endplate signal and rod breakage were noticed on postoperative 4 month follow-up radiographs. (C, D) 1mm-fine cutting CT showed punched-out lesion on endplate which was strongly suggestive finding of intervertebral osteomyelitis.

• 

  Fig. 2. Osteomyelitis around pedicle screws. (A,B) A pedicle screw cut out upper endplate at 3 month follow-up. (C,D) T1 view showed low signal on vertebral body with suggesting osteomyelitis but there was no signal change on soft tissue suggesting superficial or deep wound infection.

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