Experience in the treatment of implant-associated wound complications after spinal surgery

Abstract

Objective: Improvement of the treatment results of patients with implant-associated complications in the surgical site (SSI) by developing treatment tactics depending on the type of complication.Material and methods: The analysis of the treatment results of 245 patients with implant-associated complications of SSI was carried out in patients with various pathologies of the spine who underwent inpatient treatment in the neurosurgical department no. 3 in Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 in the period from 2015 to 2020.Results: Out of the 245 wound complications identified in clinic, partial or complete resolution of the problems was achieved in 241 (98.36%) cases. In 4 patients (1.63%), a negative trend was noted, even though the removal of the metal structure and the application and change of vacuum assisted closure (VAC) dressings were carried out in a timely manner. In these 4 cases, the generalization of the infectious process led to lethal outcome.Conclusion: In a neurosurgical department with a high surgical activity, wound complications after spinal surgery using spinal implants, occur in no more than 2.36% of cases, provided that a set of preventive measures are carried out. More often, such complications develop after operations on the lumbar spine from the posterior access for infectious (16.58%) or oncological diseases (11.76%). The depth of suppuration, the period of the complication development from the moment of surgery, as well as the presence or absence of an interbody bone or fibrous block play a crucial role in the decision on the implants removal. In patients with implant-associated infections of the area of surgical intervention on the spine, the use of the proposed tactics and VAC bandages allowed to achieve positive treatment results in 98.36% of cases.