Management of Wound Infection after Lumbar Spine Fusion with Instruments

Hwang, Gyo Jun; Kuh, Sung Uk; Chin, Dong Kyu; Cho, Yong Eun; Kim, Young Soo

Abstract

OBJECTIVE
This study is performed to evaluate the risk factors, clinical manifestations, treatments, and prognostic factors among patients with postoperative wound infection after spinal instrumentation. METHODS: The records and radiologic data of 28 patients diagnosed as postoperative wound infection from Jan. 1991 to Oct. 2002 who had underwent spinal instrumentation initially were retrospectively evaluated. RESULTS: All patients(mean age, 50.4 yrs) diagnosed as postoperative wound infection and subsequently received IV antibiotics and continuous irrigation system. The 13 among 28 cases had significant preoperative risk factors(for example, diabetes mellitus, obesity, alcoholism, long-term corticosteroid usage, and chronic renal failure). Infection was diagnosed at an average of 15.9 days after operation. The most common presenting features were local heating, fever, and wound discharge. All patients could be discharged after infection control. At follow up evaluation, 21 case(75%) have not shown recurrence but, the recurrence was developed among 7 cases. The C-reactive protein(CRP) was more correlated with clinical outcomes than other laboratory findings and the recurred group exhibited significant(p<0.05) higher CRP level, compared with the non-recurred group, from 7 days to 21 days after operation. CONCLUSION: Without removal of instruments, surgical removal of infective tissues and continuous irrigation with susceptible antibiotics can be effective in the treatment of postoperative wound infection after spinal instrumentation. CRP level can be an effective parameter of infection treatment and prognosis.