Preservation of Spinal Instrumentation After Development of Postoperative Bacterial Infections in Patients Undergoing Spinal Arthrodesis

Study Design: This is a retrospective review. Objective: The purpose of this study is to evaluate the efficacy of medical and surgical management of postoperative infections after the placement of spinal instrumentation in the context of retaining the instrumentation. Summary of Background Data: The implementation of spinal instrumentation for the treatment of various spinal conditions is associated with a risk of developing a postoperative wound infection. An aggressive medical and surgical approach is necessary for eradication of subfascial infections and treatment is often performed with the guidance of infectious diseases consultants. These medical specialists frequently recommend removal of the implanted spinal instrumentation due to the concern for the potential of persistent microbial infection resulting from the formation of bacteria harboring biofilm on the indwelling spinal hardware. Methods: Of 854 consecutive patients who had undergone spinal instrumentation by the senior author, 17 patients were identified who developed postoperative infections, 16 of which were treated by the senior author. Results: All patients underwent surgical debridement and received antimicrobial therapy in consultation with the infectious diseases consultants. Spinal instrumentation was preserved in all cases. Two patients had clinical and radiologic evidence of nonunion and later underwent a staged instrumentation revision procedure. Eradication of the infection was successful in all patients. The mean follow-up period was 2.1 years (range, 12 mo to 4.5 y). Conclusions: A combination of aggressive surgical debridement with microbial-guided pharmacotherapy enabled infection cure in all patients with postoperative bacterial infections after spinal instrumentation. Adjunct measures including the use of wound vacuum devices and long-term suppressive antimicrobial therapy were also used in high-risk patients. These results show that postoperative bacterial infections in the setting of spinal instrumentation can be successfully treated without removing titanium alloy instrumentation.