Surgical site infection rates after minimally invasive spinal surgery

Clinical article

Restricted access

Object

Postoperative surgical site infections (SSIs) have been reported after 2–6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used.

Methods

A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review.

Results

The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%.

Conclusions

Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.

Abbreviations used in this paper: MED/F = micro- or endoscopic discectomy or foraminotomy; MEDS = micro- or endoscopic decompression of stenosis; MISS = minimally invasive spinal surgery; SSI = surgical site infection.

Article Information

Address correspondence to: John E. O'Toole, M.D., Rush University Medical Center, Department of Neurosurgery, 1725 West Harrison Street, Suite 970, Chicago, Illinois 60612. email:john_otoole@rush.edu.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Apisarnthanarak AJones MWaterman BMCarroll CMBernardi RFraser VJ: Risk factors for spinal surgical-site infections in a community hospital: a case-control study. Infect Control Hosp Epidemiol 24:31362003

    • Search Google Scholar
    • Export Citation
  • 2

    Aryan HENewman CBNottmeier EWAcosta FL JrWang VYAmes CP: Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques. J Neurosurg Spine 8:2222292008

    • Search Google Scholar
    • Export Citation
  • 3

    Barker FG II: Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51:3914012002

  • 4

    Beiner JMGrauer JKwon BKVaccaro AR: Postoperative wound infections of the spine. Neurosurg Focus 15:3E142003

  • 5

    Brown EMPople IKde Louvois JHedges ABayston REisenstein SM: Spine update: prevention of postoperative infection in patients undergoing spinal surgery. Spine 29:9389452004

    • Search Google Scholar
    • Export Citation
  • 6

    Calderone RRGarland DECapen DAOster H: Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:1711821996

    • Search Google Scholar
    • Export Citation
  • 7

    Calderone RRThomas JC JrHaye WAbeles D: Outcome assessment in spinal infections. Orthop Clin North Am 27:2012051996

  • 8

    Chaudhary SBVives MJBasra SKReiter MF: Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med 30:4414512007

    • Search Google Scholar
    • Export Citation
  • 9

    Cheng MTChang MCWang STYu WKLiu CLChen TH: Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 30:168916932005

    • Search Google Scholar
    • Export Citation
  • 10

    Christodoulou AGGivissis PSymeonidis PDKarataglis DPournaras J: Reduction of postoperative spinal infections based on an etiologic protocol. Clin Orthop Relat Res 444:1071132006

    • Search Google Scholar
    • Export Citation
  • 11

    Collins IWilson-MacDonald JChami GBurgoyne WVineyakam PBerendt T: The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 17:4454502008

    • Search Google Scholar
    • Export Citation
  • 12

    Dobzyniak MAFischgrund JSHankins SHerkowitz HN: Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery. Spine 28:E453E4552003

    • Search Google Scholar
    • Export Citation
  • 13

    Emel EKaragoz Guzey FGuzey DSeyithanoglu HSel BAlatas I: Delayed infection 6 years after spinal instrumentation: a case report. Turk Neurosurg 17:1161202007

    • Search Google Scholar
    • Export Citation
  • 14

    Fang AHu SSEndres NBradford DS: Risk factors for infection after spinal surgery. Spine 30:146014652005

  • 15

    Fessler RGKhoo LT: Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 51:5 SupplS37S452002

    • Search Google Scholar
    • Export Citation
  • 16

    Fessler RGO'Toole JEEichholz KMPerez-Cruet MJ: The development of minimally invasive spine surgery. Neurosurg Clin N Am 17:4014092006

    • Search Google Scholar
    • Export Citation
  • 17

    Fountas KNKapsalaki EZNikolakakos LGSmisson HFJohnston KWGrigorian AA: Anterior cervical discectomy and fusion associated complications. Spine 32:231023172007

    • Search Google Scholar
    • Export Citation
  • 18

    Friedman NDSexton DJConnelly SMKaye KS: Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol 28:106010652007

    • Search Google Scholar
    • Export Citation
  • 19

    Gaynes RPCulver DHHoran TCEdwards JRRichards CTolson JS: Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 33:2 SupplS69S772001

    • Search Google Scholar
    • Export Citation
  • 20

    Ikuta KTono OTanaka TArima JNakano SSasaki K: Surgical complications of microendoscopic procedures for lumbar spinal stenosis. Minim Invasive Neurosurg 50:1451492007

    • Search Google Scholar
    • Export Citation
  • 21

    Kanafani ZADakdouki GKEl-Dbouni OBawwab TKanj SS: Surgical site infections following spinal surgery at a tertiary care center in Lebanon: incidence, microbiology, and risk factors. Scand J Infect Dis 38:5895922006

    • Search Google Scholar
    • Export Citation
  • 22

    Kanayama MHashimoto TShigenobu KOha FTogawa D: Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine 6:3273292007

    • Search Google Scholar
    • Export Citation
  • 23

    Khoo LTFessler RG: Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51:5 SupplS146S1542002

    • Search Google Scholar
    • Export Citation
  • 24

    Khoo LTPalmer SLaich DTFessler RG: Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery 51:5 SupplS166S1712002

    • Search Google Scholar
    • Export Citation
  • 25

    Kuo CHWang STYu WKChang MCLiu CLChen TH: Postoperative spinal deep wound infection: a six-year review of 3230 selective procedures. J Chin Med Assoc 67:3984022004

    • Search Google Scholar
    • Export Citation
  • 26

    Labbe ACDemers AMRodrigues RArlet VTanguay KMoore DL: Surgical-site infection following spinal fusion: a case-control study in a children's hospital. Infect Control Hosp Epidemiol 24:5915952003

    • Search Google Scholar
    • Export Citation
  • 27

    Liao JCChen WJChen LHNiu CC: Postoperative wound infection rates after posterior instrumented spinal surgery in diabetic patients. Chang Gung Med J 29:4804852006

    • Search Google Scholar
    • Export Citation
  • 28

    Lim MRLee JYVaccaro AR: Surgical infections in the traumatized spine. Clin Orthop Relat Res 444:1141192006

  • 29

    Mastronardi LTatta C: Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases. Surg Neurol 61:1291352004

    • Search Google Scholar
    • Export Citation
  • 30

    Milstone AMMaragakis LLTownsend TSpeck KSponseller PSong X: Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion. Pediatr Infect Dis J 27:7047082008

    • Search Google Scholar
    • Export Citation
  • 31

    Mirovsky YFloman YSmorgick YAshkenazi EAnekstein YMillgram MA: Management of deep wound infection after posterior lumbar interbody fusion with cages. J Spinal Disord Tech 20:1271312007

    • Search Google Scholar
    • Export Citation
  • 32

    O'Toole JEEichholz KMFessler RG: Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am 17:4915062006

    • Search Google Scholar
    • Export Citation
  • 33

    O'Toole JESheikh HEichholz KMFessler RGPerez-Cruet MJ: Endoscopic posterior cervical foraminotomy and discectomy. Neurosurg Clin N Am 17:4114222006

    • Search Google Scholar
    • Export Citation
  • 34

    Olsen MAMayfield JLauryssen CPolish LBJones MVest J: Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:1491552003

    • Search Google Scholar
    • Export Citation
  • 35

    Olsen MANepple JJRiew KDLenke LGBridwell KHMayfield J: Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62692008

    • Search Google Scholar
    • Export Citation
  • 36

    Ozgur BMAryan HEPimenta LTaylor WR: Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:4354432006

    • Search Google Scholar
    • Export Citation
  • 37

    Palmer S: Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients. Neurosurg Focus 13:2E52002

    • Search Google Scholar
    • Export Citation
  • 38

    Pappou IPPapadopoulos ECSama AAGirardi FPCammisa FP: Postoperative infections in interbody fusion for degenerative spinal disease. Clin Orthop Relat Res 444:1201282006

    • Search Google Scholar
    • Export Citation
  • 39

    Patel NBagan BVadera SMaltenfort MGDeutsch HVaccaro AR: Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 6:2912972007

    • Search Google Scholar
    • Export Citation
  • 40

    Perez-Cruet MJFoley KTIsaacs RERice-Wyllie LWellington RSmith MM: Microendoscopic lumbar discectomy: technical note. Neurosurgery 51:5 SupplS129S1362002

    • Search Google Scholar
    • Export Citation
  • 41

    Picada RWinter RBLonstein JEDenis FPinto MRSmith MD: Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13:42452000

    • Search Google Scholar
    • Export Citation
  • 42

    Sasso RCGarrido BJ: Postoperative spinal wound infections. J Am Acad Orthop Surg 16:3303372008

  • 43

    Schnoring MBrock M: [Prophylactic antibiotics in lumbar disc surgery: analysis of 1,030 procedures.]. Zentralbl Neurochir 64:24292003. (Ger)

    • Search Google Scholar
    • Export Citation
  • 44

    Spanu GMarchionni MAdinolfi DKnerich R: Complications following anterior cervical spine surgery for disc diseases: an analysis of ten years experience. Chir Organi Mov 90:2292402005

    • Search Google Scholar
    • Export Citation
  • 45

    Tenney JHVlahov DSalcman MDucker TB: Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis. J Neurosurg 62:2432471985

    • Search Google Scholar
    • Export Citation
  • 46

    Tredway TLSantiago PHrubes MRSong JKChristie SDFessler RG: Minimally invasive resection of intradural-extramedullary spinal neoplasms. Neurosurgery 58:1 SupplONS52ONS582006

    • Search Google Scholar
    • Export Citation
  • 47

    Valentini LGCasali CChatenoud LChiaffarino FUberti-Foppa CBroggi G: Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 62:88962008

    • Search Google Scholar
    • Export Citation
  • 48

    Vender JRHester SHoule PJChoudhri HFRekito AMc-Donnell DE: The use of closed-suction irrigation systems to manage spinal infections. J Neurosurg Spine 3:2762822005

    • Search Google Scholar
    • Export Citation
  • 49

    Weinstein MAMcCabe JPCammisa FP Jr: Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:4224262000

    • Search Google Scholar
    • Export Citation
  • 50

    Whitehouse JDFriedman NDKirkland KBRichardson WJSexton DJ: The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:1831892002

    • Search Google Scholar
    • Export Citation
  • 51

    Wimmer CGluch HFranzreb MOgon M: Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:1241281998

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 342 342 29
Full Text Views 158 158 9
PDF Downloads 94 94 6
EPUB Downloads 0 0 0

PubMed

Google Scholar