The Management and Outcome of Spinal Implant Infections: Contemporary Retrospective Cohort Study
Open Access
- 1 April 2007
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 44 (7), 913-920
- https://doi.org/10.1086/512194
Abstract
Background. Spinal implant infections provide unique diagnostic and therapeutic challenges. Methods. We conducted a retrospective cohort study to evaluate risk factors for treatment failure in patients with early- and late- onset spinal implant infections at the Mayo Clinic (Rochester, MN) during 1994–2002. Results. We identified 30 patients with early-onset spinal implant infection and 51 patients with late-onset spinal implant infection. Twenty-eight of 30 patients with early-onset infection were treated with debridement, implant retention, and antimicrobial therapy. The estimated 2-year cumulative probability of survival free of treatment failure for patients with early-onset infection was 71% (95% confidence interval [CI], 51%–85%). Thirty-two of 51 patients with late-onset infection were treated with implant removal. Their estimated 2-year cumulative probability of survival free of treatment failure was 84% (95% CI, 66%–93%). For patients with early-onset infections, receiving oral antimicrobial suppression therapy was associated with increased cumulative probability of survival (hazard ratio, 0.2; 95% CI, 0.1–0.7). For patients with late-onset infections, implant removal was associated with increased cumulative probability of survival (hazard ratio, 0.3; 95% CI, 0.1–0.7). Conclusions. Early-onset spinal implant infections are successfully treated with debridement, implant retention, and parenteral followed by oral suppressive antimicrobial therapy. Implant removal is associated with successful outcomes in late-onset infections.Keywords
This publication has 18 references indexed in Scilit:
- Spinal-Fusion Surgery — The Case for RestraintNew England Journal of Medicine, 2004
- Delayed infection after instrumented spine surgery: case reports and review of the literatureThe Spine Journal, 2003
- Point of ViewSpine, 2001
- Late Operative Site Pain With Isola Posterior Instrumentation Requiring Implant RemovalSpine, 2001
- Deep Wound Infections After Neuromuscular Scoliosis SurgerySpine, 2000
- Delayed Infection After Elective Spinal Instrumentation and FusionSpine, 1997
- Wound infections following spinal fusion with posterior segmental spinal instrumentation.Clinical Infectious Diseases, 1997
- Salvage of Instrumented Lumbar Fusions Complicated by Surgical Wound InfectionSpine, 1996
- The Patient Record in EpidemiologyScientific American, 1981
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958