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Spinal Implants Can Be Inserted in Patients With Deep Spine Infection: Results From a Large Cohort Study

Dennis Hey, Hwee Weng MBBS, MRCS, MMed, MCI, FRCSEd, FAMS; Nathaniel Ng, Li Wen MBBS (Sing); Tan, Chuen Seng BSc (Hons), MSc, PhD; Fisher, Dale MBBS, FRACP, DTM&H; Vasudevan, Anupama BDS, MPH; Liu, Ka-Po Gabriel MBBCh, MSc, FRCS, FRCSEd; Thambiah, Joseph Shantakumar MBBS, MMed, FRCS, FAMS; Kumar, Naresh MBBS, MS, DNB, FRCS, DM; Lau, Leok-Lim MBBS, BA, MBBCh, MRCS, MMed, FRCS; Wong, Hee-Kit MBBS, MMed, FRCS, MCh, FAMS; Tambyah, Paul Anantharajah MBBS, MD

doi: 10.1097/BRS.0000000000001747
Surgery

Study Design. A retrospective, cohort study of 84 patients with deep spine infection managed at a major tertiary hospital over 14 years with a minimum follow up of 2 years.

Objective. To determine the role of instrumentation in spines with deep infection.

Summary of Background Data. It is often believed that implants should not be inserted in patients with deep spine infection because of the risk of persistent or recurrent infection. However, there are often concerns about spinal stability and a paucity of evidence to guide clinical practice in this field.

Methods. We compared the mortality, reoperation, and reinfection rates in patients with spine infection treated with antibiotics alone, antibiotics with debridement, and antibiotics with debridement and instrumentation. Significant outcome predictors were determined using multivariable logistic regression model.

Results. Forty-nine males and 35 females with a mean age was 62.0 years had spine infection affecting the lumbar spine predominantly. The most common form of infection was osteomyelitis and spondylodiscitis (69.4%). Staphylococcus aureus was the most common causative organism (61.2%).

There was no difference in terms of reoperation or relapse for patients treated with antibiotics alone, antibiotics with debridement, or antibiotics with debridement and instrumentation. However, compared with antibiotics alone, the crude inhospital mortality was lower for patients treated with instrumentation (odds ratio, OR, 0.82; P = 0.01), and antibiotics with debridement (OR 0.80; P = 0.02).

Conclusion. Spinal instrumentation in an infected spine is safe and not associated with higher reoperation or relapse rates. Mortality is lower for patients treated with instrumentation.

Level of Evidence: 3

*University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore

Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.

Address correspondence and reprint requests to Hwee Weng Dennis Hey, MBBS, MRCS, MMed, MCI, FRCSEd, FAMS, University Orthopedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore; E-mail: dennis_hey@nuhs.edu.sg

Received 24 September, 2015

Revised 5 March, 2016

Accepted 2 June, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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