Experience in the management of post-operative spinal infection

Background data: Post spinal surgery infection is not uncommon. It is considered as one of the most annoying complication following surgery on the spine. The major burdens of post spinal surgery infection are time and money consuming. Infections have a considerable effect on post-operative morbidity and mortality. Purpose: The aim of this study was to identify the possible risk factors, preventive measures, diagnostic tools and the ideal management procedures. Study design: Retrospective study. Patients and methods: This is a retrospective study which was carried out on 35 patients operated upon (either primary or revision) for variable spinal lesions from 2006 till 2016 and complicated by post spinal surgery infection. No patient was operated upon for primary pre-existing spinal infection or congenital lesions. Patients were operated upon by same surgeon in the same hospital. On presentation, the patients were diagnosed to have post-operative infection by clinical examination, laboratory and radiological investigations. All patients were re-admitted to the hospital where the proper management was done. Results: Most of cases were associated with pre-operative risk factors and intra or post-operative complications. Cervical disc prolapse (8 patients) was the most common lesion in the cervical region group, whereas lumbar disc prolapse (12 patients) was the most common lesion in lumbar group. Six patients suffered from complications (durotomy in 5 patients and right common iliac artery injury in one patient). Superficial infection was encountered in 12 patients and deep infection was diagnosed in 19 patients, whereas combined infection was diagnosed in 4 patients. Surgical management that needed general anesthesia was provided to 22 patients whereas conservative management was provided to 13 patients. Out of 35 cases, only one patient died from the complications of infection. Conclusion: Post spinal surgery infection is a devastating complication that needs multi-modalities for prevention and control. Neutralization of the pre-operative risk factors can dramatically reduce the post-operative infections. Once diagnosed, the patients with infection must be hospitalized and extensive management should be applied.