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. 2018 Dec;8(4 Suppl):37S-43S.
doi: 10.1177/2192568217745512. Epub 2018 Dec 13.

Postoperative Spine Infection: Diagnosis and Management

James Dowdell  1 , Robert Brochin  1 , Jun Kim  1 , Samuel Overley  2 , Jonathan Oren  3 , Brett Freedman  4 , Samuel Cho  1
Affiliations

Postoperative Spine Infection: Diagnosis and Management

James Dowdell et al. Global Spine J. 2018 Dec.

Abstract

Study design: Review article.

Objectives: A review of the literature on postoperative spinal infections, their diagnosis, and management.

Methods: A systematic computerized Medline literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The electronic databases were searched for publication dates from the last 10 years. The searches were performed from Medical Subject Headings (MeSH) used by the National Library of Medicine. Specifically, MeSH terms "spine," "infections," "management," and "diagnosis" were used.

Results: Currently, the gold standard for diagnosis of postoperative spine infection is positive deep wound culture. Many of the current radiologic and laboratory tests can assist with the initial diagnosis and monitoring treatment response. Currently erythrocyte sedimentation rate, C-reactive protein, computed tomography scan, and magnetic resonance imaging with and without contrast are used in combination to establish diagnosis. Management of postoperative spine infection involves thorough surgical debridement and targeted antibiotic therapy.

Conclusions: Postoperative spine infection is a not uncommon complication following surgery that may have devastating consequences for a patient's short- and long-term health. A high index of suspicion is needed to make an early diagnosis.

Keywords: diagnosis; infection; management; postoperative; spine.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Lumbar spine radiographs taken 1 month postoperatively (A) and 2 months postoperatively (B). The 2-month postoperative radiograph shows significant L3-4 endplate erosions indicative of infection.
Figure 2.
Figure 2.
Computed tomography–guided biopsy of the infected disc for gram stain, culture, and speciation to determine antibiotic sensitivity.
Figure 3.
Figure 3.
Sagittal T1 postcontrast magnetic resonance imaging scan of the lumbar spine showing rim-enhancing fluid collection dorsal to laminectomy (arrow).
See this image and copyright information in PMC

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