Implant Removal for the Management of Infection After Instrumented Spinal Fusion

Abstract

We operated on 21 patients with a postoperative deep wound infection. All the patients underwent implant removal and wide debridement. One patient lost to follow-up was excluded. To reduce the number of debridements and manage uncontrolled spine infection. There are a few reports on the treatment for postoperative spinal infection after instrumented spine fusion with implant removal and wide debridement. The clinical outcomes were assessed using the Oswestry disability index, visual analog scale of pain and patients' satisfaction. The functional outcomes of the Oswestry disability index were minimal in 13 patients and moderate in 7 at final follow-up. The serial changes of visual analog scale score of pain in the back and leg showed statistically significant decline after operation. Patients' satisfaction outcomes were better in 16 patients and unchanged in 4. Six patients of the preoperative spinal fusion group included the patients that already had fusion mass well developed by the time of implant removal. Bony union was not achieved in any patient of the preoperative nonspinal fusion group (n=14) by the last follow-up. In nonspinal fusion group, mean lordotic angle before the operation was 41 degrees decreasing after the operation to 39 degrees. At the final follow-up it was 30 degrees. Mean disc space height before the operation was 11.1 mm and it decreased to 8.1 mm at the final follow-up. The mean lordotic angle and disc space height at last follow-up was larger in the spinal fusion group than in the nonspinal fusion group. Our results indicate that implant removal and wide debridement for postoperative infection after posterior instrumented spine fusion can provide satisfactory results and could be one treatment option. However, the collapse of the disc space, loss of normal lordosis, and pseudoarthrosis are inevitable in patients with early postoperative infection.