Treatment strategy for surgical site infection post posterior lumbar interbody fusion: A retrospective study

Shigeko Nakamura; Tsuyoshi Nakai; Koki Hosozawa; Yudai Tanaka; Koki Kishimoto; Kosuke Sakata; Hirokazu Iwata; Seiji Okada

doi:10.1016/j.jor.2022.03.004

Treatment strategy for surgical site infection post posterior lumbar interbody fusion: A retrospective study

J Orthop. 2022 Mar 18:31:40-44. doi: 10.1016/j.jor.2022.03.004. eCollection 2022 May-Jun.

Authors

Shigeko Nakamura¹, Tsuyoshi Nakai¹, Koki Hosozawa¹, Yudai Tanaka¹, Koki Kishimoto¹, Kosuke Sakata¹, Hirokazu Iwata¹, Seiji Okada²

Affiliations

¹ Department of Orthopaedic Surgery, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo, 664-8540, Japan.
² Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.

Abstract

Introduction: Posterior lumbar interbody fusion (PLIF) has been widely used to treat various degenerative spinal diseases. However, surgical site infection (SSI) post-PLIF is often difficult to cure. This study aimed to clarify the difference in clinical course due to the causative organism and develop a treatment strategy for SSI post-PLIF.

Methods: Between January 2011 and March 2019, 581 PLIF surgeries were performed at our hospital. Deep SSI occurred in 14 patients who were followed up for more than 2 years. Causative bacterial species were diagnosed by preoperative puncture and/or intraoperative drainage or by tissue culture in 13 patients and by intradiscal puncture in one patient who underwent conservative treatment. Of the 13 patients who underwent surgeries for infection, 10 had Propionibacterium acnes (Group A; n = 4) or coagulase-negative Staphylococcus (CNS) (Group B; n = 6) as the causative bacterial species. Groups A and B were retrospectively compared in terms of age, sex, number of segments, presence of diabetes mellitus, operation time, blood loss, C-reactive protein on hematological examination, the elapsed time to diagnosis (ETD), the presence of clinical findings such as heat, redness, swelling, and discharge from the wound and healing time.

Results: All infections were eradicated with surgery except in one patient whose causative bacteria was CNS; cages were finally removed in 11 patients. There was a significant difference (P = 0.0105) in the ETD and clinical findings (P = 0.0476) between Groups A and B. Posterior one-stage simultaneous revision (POSSR) was performed in nine patients, of whom eight were cured and one required additional surgery.

Conclusions: The ETD and clinical findings were significantly different in SSI cases caused by different bacteria, which will be useful in predicting the causative bacteria in future cases. For the treatment of deep SSI post-PLIF, POSSR was effective.

Keywords: Coagulase-negative staphylococcus; Elapsed time to diagnosis; Posterior lumbar interbody fusion; Propionibacterium acnes; Surgical site infection.