Postoperative spinal wound infections and postprocedural diskitis

Abstract

Background/objective: Postprocedural infections are a significant cause of morbidity after spinal interventions.

Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included.

Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management.

Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae.

Figure 1. Lateral plain radiograph of a patient with recurrent back and leg pain 3 weeks after a percutaneous diskectomy at L3–L4.

Figure 2. Same patient 3 weeks later showing loss of height and endplate rarefaction at L3–L4.

Figure 3. Sagittal reformatted CT of the same patient showing the endplate destruction associated with diskitis/osteomyelitis.

Figure 4. MRI of a patient who developed diskitis after L4–L5 microdiskectomy. Note the increased signal intensity of the endplates and disk on this T2-weighted image.

Figure 5. Sagittal MRIs of a patient who developed osteomyelitis and epidural abscess after anterior-posterior spinal fusion with corpectomy. T2-weighted MRI (A) and sagittal T1 after administration of gadolinium (B). Note the epidural abscess that is well delineated on the post-gadolinium image.

Figure 6. Sagittal reformatted CT after anterior debridement and strut grafting for the patient with postoperative osteomyelitis shown in Figure 4. The patient later underwent a staged posterior fusion with instrumentation.

Figure 7. Intraoperative photograph of a patient who developed a severe surgical site infection after an extensive posterior thoracolumbar fusion. Note the extensive granulation tissue that was induced by the use of the VAC system (A). (B) Rotational muscle flap that was later done by the plastic surgery service for definitive closure.