Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct 29;4(Suppl 5):S392-403.
doi: 10.4103/2152-7806.120783. eCollection 2013.

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Manish K Kasliwal  1 , Lee A Tan, Vincent C Traynelis
Affiliations

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Manish K Kasliwal et al. Surg Neurol Int. .

Abstract

Background: Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Every occurrence produces patient morbidity, which may adversely affect long-term outcome and increases health care costs.

Methods: A comprehensive review of the literature from 1990 to 2012 was performed utilizing PubMed and several key words: Infection, spine, instrumentation, implant, management, and biofilms. Articles that provided a current review of the pathogenesis, diagnosis, prevention, and management of instrumented spinal infections over the years were reviewed.

Results: There are multiple risk factors for postoperative spinal infections. Infections in the setting of instrumentation are more difficult to diagnose and treat due to biofilm. Infections may be early or delayed. C Reactive Protein (CRP) and Magnetic Resonance Imaging (MRI) are important diagnostic tools. Optimal results are obtained with surgical debridement followed by parenteral antibiotics. Removal or replacement of hardware should be considered in delayed infections.

Conclusions: An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight in the pathogenesis and management of infected spinal implants. This literature review highlights the mechanism, pathogenesis, prevention, and management of infection after spinal instrumentation. It is important to accurately identify and treat postoperative spinal infections. The treatment is often multimodal and prolonged.

Keywords: Biofilm; infection; instrumentation; spinal surgery.

PubMed Disclaimer

References

    1. Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD. Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord. 1995;8:278–83. - PubMed
    1. Ahmed R, Greenlee JD, Traynelis VC. Preservation of spinal instrumentation after development of postoperative bacterial infections in patients undergoing spinal arthrodesis. J Spinal Disord Tech. 2012;25:299–302. - PubMed
    1. Ahmed R, Severson MA, Traynelis VC. Role of hyperbaric oxygen therapy in the treatment of bacterial spinal osteomyelitis. J Neurosurg Spine. 2009;10:16–20. - PubMed
    1. Alazraki N, Dries D, Datz F, Lawrence P, Greenberg E, Taylor A., Jr Value of a 24-hour image (four-phase bone scan) in assessing osteomyelitis in patients with peripheral vascular disease. J Nucl Med. 1985;26:711–7. - PubMed
    1. Apisarnthanarak A, Jones M, Waterman BM, Carroll CM, Bernardi R, Fraser VJ. Risk factors for spinal surgical-site infections in a community hospital: A case-control study. Infect Control Hosp Epidemiol. 2003;24:31–6. - PubMed