Management of Deep Infection after Posterior Spinal Instrumentation with Prolonged Suction Drainage

Abstract

Study Design : A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation. Objectives : Analysis of the inherent risk factors associated with deep infection and the efficacy of management with prolonged suction drainage without removal of implants. Summary of Literature Review : Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still controversial because it may cause loss of spinal stability. Materials and Methods : Five cases of postoperative deep infection after posterior spinal fixation from May 1996 to May 2000 were investigated about combined general illness, features of infection, various profiles on management of the infection with surgical irrigation and debridement followed by prolonged suction drainage, and final outcomes. Results : Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, fever were observed since average 18.8th day postoperatively. By only one surgical procedure for each patient followed by prolonged suction drainage for mean 19.2 days and administration of IV antibiotics for average 43.6 days followed by oral antibiotics for 33.8 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion. Conclusion : Irrigation and debridement accompanied by prolonged suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods in controlling deep infection after posterior instrumentation and in maintaining the postoperative stability of spine.