Management of Deep Wound Infection After Posterior Lumbar Interbody Fusion With Cages

ABSTRACT

STUDY DESIGN: Retrospective study OBJECTIVES: The purpose of this study was to analyze patients who developed deep wound infections after receiving PLIF for degenerative lumbar disease, and report the treatment outcomes. SUMMARY OF LITERATURE REVIEW Few studies have examined deep wound infections after PLIF, and there is some controversy regarding whether screws or cages need to be removed to treat infections. MATERIALS AND METHODS: Nine cases(spinal stenosis 6, spondylolisthesis 3) developed a deep wound infection after PLIF from 2001 to 2007. The mean follow up was 48 months (24-72). The clinical results were evaluated using MacNab's criteria. RESULTS: The diagnosis of infection was made based on the clinical symptoms and signs, and inflammatory markers, such as ESR and CRP. The time to diagnosis was less than one week (2), three weeks (2), six weeks (1) and three months or more (4). Bacterial identification was performed on seven cases. MRSA was detected in one of them, and no bacteria were identified in the other six. In two of them, the infection subsided with antibiotic therapy only. In 7 cases, removal of the cage and anterior iliac strut graft was needed for infection control. In four cases, loosened screws were removed during debridement. In 2 cases, additional surgery for pseudarthrosis was required after curing the infection. CONCLUSIONS: In deep infections after PLIF, early diagnosis and bacterial identification are important for reducing the need for a later radical operation. It is recommended that blood markers of infection be measured with a short follow-up period. In a case of persistent infection against prolonged antibiotics, removal of the cage or screw is needed to treat the infection earlier.