Abstract
BackgroundIn cases of postoperative deep wound infection after interbody fusion with cages, it is often difficult to decide whether to preserve or remove the cages, and there is no consensus on the optimal approach for removing cages. The aim of this study was to investigate the surgical management of cage infection after lumbar interbody fusion.MethodsA retrospective study was conducted between January 2012 and August 2018. Patients were included if they had postoperative deep wound infection and required cage removal. Clinical outcomes, including operative parameters, visual analog scale, neurologic status, and fusion status, were assessed and compared between anterior and posterior approaches for cage removal.ResultsOf 130 patients who developed postoperative infection and required surgical debridement, 25 (27 levels) were diagnosed with cage infection. Twelve underwent an anterior approach, while 13 underwent cage removal with a posterior approach. Significant differences were observed between the anterior and posterior approaches in elapsed time to the diagnosis of cage infection, operative time, and hospital stay. All patients had better or stationary American Spinal Injury Association impairment scale, but one case of recurrence in adjacent disc 3 months after the surgery.ConclusionsBoth anterior and posterior approaches for cage removal, followed by interbody debridement and fusion with bone grafts, were feasible methods and offered promising results. An anterior approach often requires an additional extension of posterior instrumentation due to the high incidence of concurrent pedicle screw loosening. The use of an endoscope-assisted technique is suggested to facilitate safe removal of cages.
Highlights
Because of rising life expectancy, the demand for spinal surgery among elderly individuals has increased, and lumbar spinal fusion has become one of the most commonly performed spinal surgery procedures [1, 2]
Patients were included for statistical analysis if they (1) were aged ≥ 18 years at the time of surgery; (2) underwent lumbar spine interbody fusion with cages via anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), or posterior lumbar interbody fusion (PLIF); (3) had surgical debridement due to postoperative wound infection; and (4) required removal of a cage due to the impression of cage infection
Cage infection was diagnosed based on the following conditions: (1) the patient developed progressive signs and symptoms, such as fever, back pain, and sciatica postoperatively; (2) follow-up radiographic images showed vertebral end plate destruction with cage subsidence or cage migration, and follow-up magnetic resonance imaging (MRI) revealed signal changes of abutting vertebrae in T1weighted images or obvious accumulation of excessive fluid around the cage space in T2-weighted images; (3) laboratory data revealed leukocytosis, as well as elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR); (4) intraoperative findings revealed a sinus tract at the entrance of cage space; or (5) uncontrollable infection even with repeated surgical debridement with retention of the unmoved cage
Summary
Because of rising life expectancy, the demand for spinal surgery among elderly individuals has increased, and lumbar spinal fusion has become one of the most commonly performed spinal surgery procedures [1, 2]. 62.5% patients treated with posterior lumbar interbody fusion (PLIF) who had a postoperative infection were found to have infectious spondylitis around the interbody cages and grafted bone [10]. In the management of deep wound infection after instrumentation and interbody fusion, it is often difficult to decide whether to preserve or remove the cage, because the removal of a cage is technically demanding, associated with a high risk of dural and root injury, and may result in spinal instability. In cases of postoperative deep wound infection after interbody fusion with cages, it is often difficult to decide whether to preserve or remove the cages, and there is no consensus on the optimal approach for removing cages. The aim of this study was to investigate the surgical management of cage infection after lumbar interbody fusion
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
