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Review
. 2024 Dec 17;79(6):e65-e71.
doi: 10.1093/cid/ciae436.

State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections

Don Bambino Geno Tai  1 , Robin Patel  2   3 , Francis Lovecchio  4 , Thomas Kwee  5 , Marjan Wouthuyzen-Bakker  6
Affiliations
Review

State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections

Don Bambino Geno Tai et al. Clin Infect Dis. .

Erratum in

Abstract

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed.

Keywords: antimicrobial therapy; biofilm; implant retention; spinal fusion; surgical site infection.

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Conflict of interest statement

Potential conflicts of interest . R. P. reports grants from MicuRx Pharmaceuticals and Biofire. R. P. is a consultant to PhAST, Day Zero Diagnostics, Abbott Laboratories, Sysmex, Deepull Diagnostics, S.L., Netflix, Oxford Nanopore Technologies, and CARB-X. In addition, R. P. has a patent on a Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued. R. P. receives honoraria from Up-to-Date and the Infectious Diseases Board Review Course. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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