The Correlations Of Surgical Site Infection In Lumbar Spine And Cerebrospinal Fluid Leakage

Surgical site infection is a rare complication after spinal internal fixation surgery,frequently occurring about one week after surgery,often presenting acute onset,difficult to cure,clear symptoms,but difficult to diagnose.Most of the patients presented fever(local or systemic),local swelling,wound exudation and other symptoms,and a small number of cases were infected and invaded the spinal canal.At the same time,patients were accompanied by vague consciousness.Although most of the cases were only manifested in local infection symptoms,the infection was easy to get worse and worse,prolonged wound healing time,and required a lot of time for treatment.It was also extremely difficult to confirm the complete cure of infection.The results were local wound sinus,long-term fever,internal fixation exposure and even death.It can also lead to increased costs and even the risk of needing a second operation.According to relevant statistics,the incidence of postoperative infection of lumbar spine is about 0.7-12.0%worldwide.Risk factors for infection after spinal surgery include patient-related risk factors(age,obesity,diabetes,smoking)and surgicity-related risk factors(approach,fusion site,fusion degree,internal fixation,duration more than 3 hours,blood loss,and postoperative drainage time more than 3 days).Most infections(about 89%)occur early(within 1 month after surgery),and a small proportion(about 7%)occur late(1-3 months after surgery).Deep incision infection was the most common type of SSI(46.7%).Gram-positive infections accounted for 80%of all infections.Coagulase-negative staphylococcal infections accounted for 58%of gram-positive infections.Current studies show that the treatments of postoperative infection of the lumbar spine are mainly on the basis of the site of infection,the type of bacteria and the symptoms of the patients.For superficial localized infection,conservative treatment is considered.Patients need to receive broad-spectrum antibiotic treatment in the early stage,as well as wound secretion culture and drug sensitivity test.Periodically review laboratory indicators were conducted to observe treatment effectiveness.However,in the face of intractable,deep infection,whether to perform surgical treatment is still a difficult problem for patients and doctors.Whether internal fixations should be preserved after thorough debridement is also partly controversial.Due to the complexity of spinal surgery,the incidence of cerebrospinal fluid(CSF)leakage due to dural tears is high.When cerebrospinal fluid leakage occurs,most studies show that a torn dura is stitched up to stop the leakage.Prevention is the most important means of treating CSF leakage,including preoperative risk factor assessment and careful intraoperative operation.Internal fixation results in more cavity formation than conventional minimally invasive treatment.In order to prevent dura injury,paravertebral muscle tamponade is an effective measure to prevent small dura tears.In some special cases,a dural tear did not cause an arachnoid rupture,nor did the cerebrospinal fluid leak.However,due to the thin and fragile arachnoid membrane,any increase in intra-abdominal pressure,such as sharp awakening from anesthesia,cough,constipation and urinary retention,can lead to arachnoid tear and cerebrospinal fluid leakage.Therefore,even if the operation was fine,some patients experienced cerebrospinal fluid leakage symptoms after operation.At the same time,despite the widespread use of direct suture to repair dural tears,data indicate that CSF leakage is present in 5%to 9%of cases.Objective:To investigate the correlations between Surgical site infection and cerebrospinal fluid leakage.To understand the impact of the co-occurrence of both on patients and medical treatment and the possible related factors,and to better guide the rational clinical treatment through clinical manifestations,laboratory examinations and imaging data.Materials and methods:1.Research objects and groupingRetrospective analysis was performed on patients with cerebrospinal fluid leakage after lumbar surgery in jingzhou central hospital of our hospital from January 2010 to December 2019(including spinal fusion,laminectomy,discectomy and vertebral body resection)as the experimental group,and patients without cerebrospinal fluid leakage after lumbar surgery as the control group.General demographic data of the patients,such as gender,height,age,weight,body mass index(BMI),occupation,smoking,drinking,basic diseases,total course of disease,etc.,were collected to exclude the possibility of preoperative infection,incomplete patient data,and patients with related spinal tumors and tuberculosis.2.Data collectionThe infection rate,average hospital stay,cost,incision drainage,healing time,bed time,probability of reoperation and mortality of the two groups were collected.To be guided by patient-related laboratory tests.3.Data analysisAll data were recorded,processed and analyzed by SPSS25.0 software.T test was used to contrast to compare differences between measurement data set,data and laboratory test results between the compared commonly used analysis of variance(P<0.05),of which the average length of hospital stay,cost,incision,healing time,bed time drain these variable variance together,can be directly using analysis of variance under the P value,the rest of the indicators of variance not neat,can not use the variance analysis of non parametric test(P<0.05).Univariate regression analysis was used to investigate the correlation between cerebrospinal fluid leakage and postoperative infection of the lumbar spine.Multivariate regression analysis was used to investigate the associated risk factors for infection.P<0.05 was set as statistically significant.Results:From January 2010 to December 2019,a total of 5614 cases of lumbar surgery were performed,4955 cases of which met the inclusion criteria.The number of infected patients were 152,and the nosocomial infection rate was about 3.06%.From January 2010 to December 2019,a total of 233 patients experienced cerebrospinal fluid leakage after lumbar surgery,of which 221 were included as standard patients,and 15 were accompanied by infection.The nosocomial infection rate was about 6.78%.In multiple regression analysis,drainage days,drainage volume and bed time were independent risk factors for CSF leakage with infection.Among all the infected patients,the cost,healing time and duration of infection(through laboratory indicators)of patients with CSF leakage were more prominent.In the experimental group,10 patients underwent two surgeries,accounting for about 66.6%of the samples.In the control group,48 patients underwent secondary surgery,accounting for 31.5%of the sample.Conclusion:SSI is a challenging postoperative complication of the spine,especially after spinal fusion.The key to preventing SSI is the risk associated with strict aseptic procedures,intraoperative irrigation,prophylactic antibiotics,and preoperative optimization of patient factors.Despite the precautions were taken,timely diagnosis and treatments are critical once a patient shows signs of infection.After successful clearance of the early infection,the internal fixation can be retained,but after spinal fusion,if oral antibiotics are required for life or the infection is not completely suppressed,removing the internal fixation to suppress the source of infection may be considered.Surgical intervention early in the treatment process can help repair complex soft tissue injuries.Treatments depend on the time and location of the infection.The time classification of SSI can be divided into early,late or incubation periods.Site classification can be localized to the disc,deep fascia,superficial fascia,and subcutaneous.Cerebrospinal fluid leakage occurs in patients after spinal surgery,which made the internal exudation of the patient’s wound serious.At the same time,because the patient’s bed time is prolonged,it caused certain obstacles to the postoperative recovery of the patient.These factors may lead to an increase in the probability of postoperative infection,and make the postoperative infection symptoms of patients more difficult to control.Because the bacteria in the infected area can spread inside the wound along with the cerebrospinal fluid,it makes the infection more uncontrolled,and there’s also the risk of intrusions into the spinal canal and intracranial infections.SSI and CFL together can lead to worse effects on patient outcomes,costs and mortality.Therefore,once the diagnosis of postoperative cerebrospinal fluid leakage and infection of patients,it is recommended to actively carry out symptomatic treatment,once the infected site of patients is not limited to superficial skin,it is necessary to consider surgical treatment of patients’ wounds.For patients with intraoperative cerebrospinal fluid leakage,dural repair and antibiotic prophylactic irrigation can be considered.