Surgical Site Infections in Spinal Surgery

Abstract

Surgical site infections (SSIs) following spinal surgery remain an important complication that requires urgent detection. Even with the use of sterile technique and antibiotic prophylaxis a significant proportion of patients develop infection, which may require reoperation and aggressive antibiotic therapy. Classically, the SSI is divided into incisional (superficial or deep) or organ/space infections, depending on the tissue compartment concerned. Clinical symptoms vary greatly, with the most frequent being fever, spinal pain, local signs of inflammation, wound discharge, and (rarely) new neurologic deficits. CT scans and MRI offer an interesting basis for the diagnosis of spinal and intraspinal infections. Inflammatory biomarkers are highly variable in their expression; the most useful are procalcitonin and amyloid serum A levels. When possible, CSF should be assessed in cases with suspected intradural infections. Causative pathogens are most often gram-positive skin flora, particularly Staphylococcus aureus. Most patients with superficial wound infections and limited deeper infections are treated with local wound care and antibiotics only, but these cases require careful monitoring and should be considered for surgery if complications arise. Operative management may be indicated for drainage or dehiscence of the incision, clinical sepsis, neurologic deficits secondary to fluid collection or mass effect, a spinal or epidural abscess, or instability from bone destruction or failure of an implant or fixation. If treated quickly and vigorously, SSI may resolve without sequelae, but complications may occur, especially in patients with deep infections. Sequels consist of spinal instability and deformity, pseudarthrosis, residual neurologic deficits, and chronic spinal pain.