Clinical Analysis Of Postoperative Deep Wound Infection After Posterior Spinal Surgery

Objective:Patients with postoperative deep wound infections after spinal instmmentation were followed and analyzed in the study, to investigate the diagnosis and treatment characteristic of postoperative deep wound infection after posterior thoracic and lumbar internal fixation.Materials and methods:From2006to2012,12patients with postoperative deep wound infection after posterior thoracic and lumbar internal fixation were treated in our hospital,7males and5females. The average age was40.5years old (range:27-68). Among them,4cases were lumbar spinal stenosis and disc herniation,2cases were lumbar spondylolisthesis caused by trauma, and6cases were thoracic and lumbar compression fracture. Of the12patients,4cases with postoperative cerebrospinal fluid leakage after initial fixation. The application of posterior internal fixation for AF nail were4cases, screw and rod system were8cases. Of the10acute infection cases,4patients were treated with antibiotics alone,6patients underwent infection early surgical debridement and closed-suction drainag. Both two delayed infection patients and two postoperative recurrence infection patients were treated with internal fixator removal, surgical debridement, and closed-suction drainag. All patient underwent an average of two and a half years follow-up, Which including infection cure and recurrence, vertebral segments pain, deformity, and the functional activity. The visual analogue scale (VAS) and Oswestry disability Index (ODI) were taken to objectify pre-and post-procedural changes in whole and groups. To evaluate the significance of the data obtained, the paired Student t-test were used. P value<0.05for statistical tests would be considered significant.Results:1. The diagnosis standards of postoperative deep wound infections were based on patient’s symptoms and signs, laboratory examinations, imaging results, puncture and bacterial culture. Including:①red, swollen, heat, pain or exudate in local incision;②temperature more than38℃; When combined with bacterial meningitis, patients showed high fever, body temperature more than39℃, intracranial hypertension, and meningeal irritation;④white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly increased after operation;⑤bacterial culture from deep incision drainage or aspiration to pus and wound exudates showed positive.⑥surgical exploration, histopathologic or imaging examination revealed deep incisional abscess or other infection evidence.2. The treatment of the infection were as follows:antibiotic treatment without surgery, early surgical debridement and irrigation of the infected wound, internal fixator removal and so on. Adjust the treatment project, base on the treatment effect. Of the10acute infection cases,4patients were treated with antibiotics alone,2of them were cured, and2were postoperative recurrence,6patients underwent infection early surgical debridement and closed-suction drainag, and all were cured. Both two delayed infection patients and the postoperative recurrence infection patients were treated with internal fixator removal, surgical debridement, and closed-suction drainag, and all were cured. The whole VAS pre-and post-procedural were (7.26±1.22) and (3.58±1.21)(P<0.001), OD1were (70.96±14.97)%and (34.36±10.20)%(P<0.001). Conclusion:1. Patients with acute infection should be immediately treated with routine antibiotic treatment, if the symptoms were obviously improved, and laboratory examination toward normal within3days, sensitivity antibiotic can be sustained until cured. On the contrary, if the symptoms and signs did not obvious change for the better or worse within3days, and laboratory examination persistent abnormalities, patients should be immediately treated with early surgical debridement and closed-suction drainag.2. For acute infection patients complicated with bacterial meningitis, early surgical debridement and closed-suction drainag should be immediately applied to avoid life-threatening.3. As for delayed infection patients complicated with sinus, internal fixator removal, surgical debridement, and closed-suction drainag should be applied. It is difficult to completely cure with the internal fixation remained.