Late Infection of Spinal Instrumentation

Shim, Jae Ik; Kim, Taik Seon; Lee, Sung Jong; Lee, Suk Ha; Lee, Dong Ki; Yu, Yoen Sik; Kim, Yun Yeup

Abstract

STUDY DESIGN: A retrospective analysis of five cases of late spinal infection after spinal instrumentation and fusion.
OBJECTIVES
These cases are reviewed to verify risk factors for late spinal infection after elective instrumentation and to manifest the treatment of this complication. SUMMARY OF LITERATURE REVIEW: Late spinal infection after elective spinal instrumentation and fusion are uncommon. The diagnosis is usually hard and requires much clinical suspicion.
MATERIALS AND METHODS
5 cases were in total 374 patients of the author's cases. These cases are reviewed retrospectively.
RESULTS
All patients reported aggravated back pain. 4 patients had elevated erythrocyte sedimentation rates, averaging 44.8 mm/hour and elevated C-reactive protein, averaging 26.2mg/L. No distance foci of infection was identified. All patients got the radiolucent zone around screw fixation site, averaging 4.6mmwidth. The organisms were S. epidermidis in 1 case and coagulase(-) staphylococcus in 1 case. All cases were treated by operative method with debridement, instrument removal with or without revision and postoperative intravenous antibiotics. The average follow-up period was 18.2 months, one patient recurred back pain at 7 months after operation.
CONCLUSION
The diagnosis of late infection after elective spinal instrumentation and fusion requires high suspicion of clinical symptoms and signs. All except one were successfully treated by operative treatment.