TY - JOUR T1 - Risk Factors for Pseudarthrosis After Surgical Site Infection of the Spine JF - International Journal of Spine Surgery JO - Int J Spine Surg DO - 10.14444/6068 SP - 6068 AU - Douglas A. Hollern AU - Barrett I. Woods AU - Neil V. Shah AU - Gregory D. Schroeder AU - Christopher K. Kepler AU - Mark F. Kurd AU - I. David Kaye AU - Paul W. Millhouse AU - Bassel G. Diebo AU - Carl B. Paulino AU - Alan S. Hilibrand AU - Alexander R. Vaccaro AU - Kris E. Radcliff Y1 - 2020/01/01 UR - http://ijssurgery.com//content/early/2020/01/07/6068.abstract N2 - Background Pseudarthrosis following spinal fusion is a complication that frequently requires revision surgery. Reported rates of pseudarthrosis after surgical site infection (SSI) range from 30% to 85%, but few studies have identified infection as an independent risk factor for its development. The purpose of this study was to determine the incidence of clinically symptomatic pseudarthrosis in patient who developed SSI following lumbar fusion and to identify factors associated with its development. Methods This was a retrospective review of a prospectively collected database. Patients who underwent spinal surgery and developed SSI between January 2005 and March 2015 with a minimum 2-year follow-up were included. Patient-specific and procedural characteristics were recorded. Presence of pseudarthrosis was determined clinically by the treating surgeon and was confirmed radiographically. All those in the Pseudarthrosis group required a revision procedure after the eradication of infection. Univariate and multivariate analyses were conducted as appropriate.Results A total of 416 patients were included. Of these, 21 (5.0%) developed symptomatic pseudarthrosis following SSI. In this cohort, multivariate regression showed that age, Charlson Comorbidity Index, male sex, and surgical approach were not significant predictors of pseudarthrosis formation. However, number of levels fused was found to be the leading predictor for pseudarthrosis development (odds ratio [OR], 1.356/level, P < .001), followed by body mass index (OR, 1.083/point, P < .009) in this cohort. The number of levels fused was found to be a significant predictor of hardware removal (OR, 1.190/level, P < .001). Of the 21 pseudarthrosis cases, 85.7% found staphylococcal species, of which 27.8% exhibited methicillin-resistant Staphylococcus aureus.Conclusions The number of spinal levels fused and body mass index are independent predictors of pseudarthrosis in patients who develop SSI after spinal fusion.Level of Evidence Level 4Clinical Relevance This is the first known study to specifically identify risk factors for the development of symptomatic pseudarthrosis. ER -