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Clinical Outcome of Deep Wound Infection After Instrumented Posterior Spinal Fusion: A Matched Cohort Analysis

Mok, James M. MD; Guillaume, Tenner J. MD; Talu, Ufuk MD; Berven, Sigurd H. MD; Deviren, Vedat MD; Kroeber, Markus MD; Bradford, David S. MD; Hu, Serena S. MD

doi: 10.1097/BRS.0b013e31819a827c
Clinical Case Series

Study Design. Retrospective case control study.

Objective. Determine the impact of infection on clinical outcome in patients undergoing posterior spinal fusion surgery.

Summary of Background Data. The outcome of patients treated for infection after spinal surgery is not well established because of variability in cohort identification, definition of infection, outcomes instrument, use of a control group, and/or sample size.

Methods. Thirty-two patients were included. Sixteen patients (“infection group”) met inclusion criteria of deep wound infection after spinal fusion with posterior segmental instrumentation (including combined approach). A 1:1 matched cohort (“control group”) was created based on primary or revision status, length of fusion, diagnosis, and age. Postoperative patient outcomes were evaluated using the physical components of SF-36 v2.0 with minimum 2-year follow-up.

Results. No significant difference in the Physical Function, Role Physical, Bodily Pain, and General Health domains was detected between the infection group and control group. Mean follow-up was 62 months. Mean Physical Component Summary was 41.4 in the infection group and 44.3 in the control group (P = 0.6). Infection occurred early in 12 patients and late in 4 patients. Most common organisms isolated were Staphylococcus epidermidis, Enterococcus sp., and Staphylococcus aureus. Multiple debridements were significantly associated with polymicrobial infections and later pseudarthrosis requiring reoperation.

Conclusion. An aggressive approach to deep wound infection emphasizing early irrigation and debridement allowed preservation of instrumentation and successful fusion in most cases. At the conclusion of treatment, patients can expect a medium-term clinical outcome similar to patients in whom this complication did not occur.

Outcomes of 16 patients with deep wound infection were compared to 16 matched controls as measured by SF-36 physical domains. No significant differences in SF-36 scores were found at a mean follow-up of 62 months.

From the Department of Orthopaedic Surgery, University of California, San Francisco, CA.

Acknowledgment date: June 27, 2008. First revision date: October 8, 2008. Acceptance date: October 9, 2008.

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

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Serena S. Hu, MD, Department of Orthopaedic Surgery, University of California, 500 Parnassus MU320W, Box 0728, San Francisco, CA 94143-0728; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.