Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: Incidence and management

The authors reviewed 817 instrumented lumbosacral fusions in adults and fou nd an incidence of 3.2% deep wound infections. The primary focus of this st udy was the management of these infections, with particular attention to wh ether the implants needed to be removed. A consulting infectious disease sp ecialist indicated that an acute infection of a low back fusion wound could not be healed without removal of the metallic implants. This opinion was i n contrast to the authors' daily experience and prompted this study. The au thors identified and reviewed 817 cases of instrumented posterior lumbosacr al arthrodeses in adults. A detailed analysis of any case with a deep wound infection was performed and yielded and infection rate of 3.2% (26 patient s). Of these, 24 achieved a clean, closed wound without removal of instrume ntation through a protocol of aggressive debridement and secondary closure. Instrumentation removal is not necessary to obtain a clean, closed wound u sing an aggressive approach with early diagnosis, vigorous debridement in t he operative room under general anesthesia, delayed primary or secondary cl osure, and appropriate antibiotic coverage.