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Research ArticleComplications

Deep Surgical-Site Infection Following Thoracolumbar Instrumented Spinal Surgery: The Experience of 25 Years

Borja de la Hera, Felisa Sánchez-Mariscal, Alejandro Gómez-Rice, Iria Vázquez-Vecilla, Lorenzo Zúñiga and Esther Ruano-Soriano
International Journal of Spine Surgery February 2021, 8019; DOI: https://doi.org/10.14444/8019
Borja de la Hera
1Department of Orthopedic Surgery, Getafe University Hospital, Madrid, Spain
2Complutense University, Madrid, Spain
MD
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Felisa Sánchez-Mariscal
3Department of Orthopedic Surgery, Rey Juan Carlos University Hospital, Madrid, Spain
MD, PHD
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Alejandro Gómez-Rice
2Complutense University, Madrid, Spain
5Department or Orthopedic Surgery, Ramón y Cajal University Hospital, Madrid
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Iria Vázquez-Vecilla
1Department of Orthopedic Surgery, Getafe University Hospital, Madrid, Spain
MD
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Lorenzo Zúñiga
1Department of Orthopedic Surgery, Getafe University Hospital, Madrid, Spain
MD
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Esther Ruano-Soriano
4Infectious Diseases Unit, Department of Internal Medicine, Getafe University Hospital, Madrid, Spain
MD
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ABSTRACT

Background Deep surgical-site infection following thoracolumbar instrumented spinal surgery (DSITIS) is a major complication in spine surgery and its impact on long-term morbidity and mortality is yet to be determined. This article describes the characteristics and evolution of DSITIS in our center over a period of 25 years.

Methods This single-center, retrospective cohort study included patients diagnosed with DSITIS between January 1992 and December 2016 and with a minimum follow-up after infection diagnosis of 1 year. The Infectious Diseases Society of America criteria and/or Centers for Disease Control and Prevention criteria were used to define DSITIS. Patient data (epidemiological and health status), surgical data, infection characteristics and presentation, isolated microorganisms, required surgical debridements, implant removal, and major complications linked to infection were evaluated.

Results A total of 174 patients (106 females) were included in the analysis. Mean follow-up after infection diagnosis was 40 months (56 patients with over 5 years follow-up). Adolescent idiopathic scoliosis, adult deformity, and degenerative lumbar stenosis were the most frequent etiologies for primary surgery. Presentation of infection was considered early (0–3 months since first surgery) in 59.2% of the cases, delayed (3–24 months) in 11.5%, and late (more than 24 months) in 29.3%. All patients were treated by surgical debridement. More than 1 surgical debridement was necessary in 20.7% of cases. Implants were removed in 46.6% of the patients (72.83% in the first surgical debridement). Most frequently isolated microorganisms were Staphylococcus spp, Enterobacteriaceae, and Cutibacterium acnes. Major complications appeared in 14.3% of the patients, and over 80% of them required major surgeries to resolve those complications.

Conclusions Late DSITIS is more frequent than previously reported. In DSITIS culprits, Staphylococcus spp, Enterobacteriaceae, and Cutibacterium acnes predominate. DSITIS produce a high rate of major complications that usually require major surgery for treatment.

Level of Evidence 3.

  • spine infection
  • surgical site infection
  • infected spinal instrumentation
  • early-onset infection
  • delayed infection
  • late-onset infection

Footnotes

  • Disclosures and COI: The authors declare no conflict of interest.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Deep Surgical-Site Infection Following Thoracolumbar Instrumented Spinal Surgery: The Experience of 25 Years
Borja de la Hera, Felisa Sánchez-Mariscal, Alejandro Gómez-Rice, Iria Vázquez-Vecilla, Lorenzo Zúñiga, Esther Ruano-Soriano
International Journal of Spine Surgery Feb 2021, 8019; DOI: 10.14444/8019

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Deep Surgical-Site Infection Following Thoracolumbar Instrumented Spinal Surgery: The Experience of 25 Years
Borja de la Hera, Felisa Sánchez-Mariscal, Alejandro Gómez-Rice, Iria Vázquez-Vecilla, Lorenzo Zúñiga, Esther Ruano-Soriano
International Journal of Spine Surgery Feb 2021, 8019; DOI: 10.14444/8019
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Keywords

  • spine infection
  • surgical site infection
  • infected spinal instrumentation
  • early-onset infection
  • delayed infection
  • late-onset infection

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