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

Yong-Min Kim; Choong-Hee Won; Eui-Seong Choi; Joong-Bae Seo; Ho-Seung Lee; Byung-Ki Cho

doi:10.4184/jkss.2001.8.4.504

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Kim, Won, Choi, Seo, Lee, and Cho: Management of Deep Infection after Posterior Spinal Instrumentation with Prolonged Suction Drainage

Original Article

Journal of Korean Spine Surg 2001;8(4):504-512.

Published online: 21 February 2001

DOI: https://doi.org/10.4184/jkss.2001.8.4.504

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

Yong-Min Kim, M.D., Choong-Hee Won, M.D., Eui-Seong Choi, M.D., Joong-Bae Seo, M.D., Ho-Seung Lee, M.D., Byung-Ki Cho, M.D.

Department of Orthopedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea

Address reprint requests to Yong-Min Kim, M.D. Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University #62 Gaesin-dong, Cheongju 360-711, Korea Tel : 82-43-269-6077, Fax : 82-43-274-8719, E-mail : ymkim@med.chungbuk.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation.

Objectives

A nalysis 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 Hemovac 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.

Keywords: Deep infection, Posterior spinal instrumentation, Prolonged suction drainage

REFERENCES

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Figures and Tables%

Fig. 1.

Diagram showing patterns of daily drainage amount via Hemovac.

Fig. 2-A.

T2 sagittal MR image shows spondylolisthesis of L3-4, L5-S1 and multilevel stenosis in a 58 year-old lady with Diabetes and obesity. Fig. 2-B. Posterior decompression and posterolateral fusion with transpedicular screw system including transverse fixation were performed.

Fig. 3.

Wound dehiscence with discharge was observed since postoperative 11th day.

Fig. 4-A.

On 14th day, the wound was reopened for thorough irrigation and debridement. TLC bar was removed to minimize dead space. Two pairs of Hemovac were inserted for drainage. Fig. 4-B. Postoperative lateral X-ray.

Fig. 5.

Anteroposterior X-ray at postoperative 6 month shows bridging of posterolateral fusion mass.

Table 1.

Profiles of Deep Infection after Posterior Spinal Instrumentation

Case	Sex/Age	Associated Problems	Initial Diagnosis	Fusion Level	Onset of Infection	Infection Sign Fever	ESR/CRP
		DM Obesity
1	F/58	Hypertension	Spinal stenosis	L3-S1	PO 8 days	Wd discharge	103 / 20.4
		Hypertension
2	M/73	DM COPD	Spinal stenosis	L4-S1	PO 18 days	Wd discharge	25 / 5.4
						Wd dehiscence
		DM Obesity				Wd dehiscence
3	F/43		Spinal stenosis	L4-S1	PO 16 days	Wd discharge	38 / 4.8
		Hypertension
						Wd swelling
4	F/65	DM	Spinal stenosis	L2-S1	PO 36 days	& pain	72 / 8.1
		Malnutrition	Spinal stenosis	T12-L2,		& pain Wd discharge
5^∗	F/66	Malnutrition	Spinal stenosis	T12-L2,	PO 16 days	Wd discharge	49 / 21.2
		Anemia	L1 compression Fx.	L4-5		Fever

^∗ : Referred case from local hospital

DM : Diabetes mellitus COPD : Chronic obstructive pulmonary disease

Wd : Wound PO : Postoperative

Table 2.

Management of Infection and Results

Case	Organism	Suscceptible Antibiotics	Duration of IV antibiotics	Duration of Oral antibiotics	Duration of Drainage	Total Amounts of Drainage	Followup Period	of CRP Normalization
1	MRSA	Vancomycin	49 days	38 days	PO 20 days	774 cc	PO 32 months	PO 48 days (0.3)
2	MSSA	Vancomycin Amikacin	35 days	36 days	PO 18 days	571 cc	PO 56 months	PO 14 days (0.1)
3	MRSE	Vancomycin	32 days	20 days	PO 21 days	120.5 cc	PO 25 months	PO 10 days (0.4)
4	MRSE	Vancomycin, Teicoplanin	42 days	60 days	PO 21 days	660 cc	PO 28 months	PO 64 days (0.3)
5	MRSA	Vancomycin	60 days	15 days	PO 16 days	304 cc	PO 18 months	PO 58 days (0.4)
MRSA : Methicillin resistance Staphylococcus aureus
MRSE : Methicillin resistance Staphylococcus epidermidis

MSSA : Methicillin sensitive Staphylococcus aureus

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