Postoperative Infections of the Spine

The incidence of postoperative infections after spinal surgery ranges from less than 1% to 15%. This rate can vary based on several surgical- and patient-related risk factors, such as the type and duration of the procedure, nutritional status, immunosuppression, and comorbidi­ties of the patient. Most surgeons routinely administer intravenous antibiotics prophylactically, and may employ other measures in an effort to prevent postoperative infection. Multiple diagnostic modalities, in conjunc­tion with examination findings, should be utilized in the assessment of possible postoperative spinal infec­tions. In particular, wound discharge or erythema, and an elevation in the erythrocyte sedimentation rate and C-reactive protein beyond expected postoperative val­ues should raise a clinician’s level of suspicion for an infection. The diagnosis of a postoperative spine infec­tion can be difficult to confirm with diagnostic imaging, given findings are not all that different from normal postoperative changes. When suspected, the preferred treatment for a postoperative spinal infection is open irrigation and aggressive debridement of all necrotic tis­sue and bone, followed by antibiotic treatment based on culture sensitivity.