Postoperative spinal deep wound infection: a six-year review of 3230 selective procedures.

BACKGROUND Postoperative wound infection remains a troublesome but common complication after spinal surgery. This study presents the 6-year experience of our surgical team with post-operative deep wound infection in Taipei Veterans General Hospital. METHODS Of 3230 selected operations, 72 cases of wound infection were identified. Thirty patients with deep wound infection were reviewed, including 17 men and 13 women at a mean age of 32 years. The pre-operative diagnoses included spondylolisthesis, scoliosis, spinal stenosis, herniated inter-vertebral disc, spinal fracture and adjacent syndrome. RESULTS In this report, different deep wound infection rates were compared between different operative procedures including (1) posterior decompression with fixation and fusion, 1.15%. (2) simple decompression (laminectomy) and disectomy, 0.37%, (3) revision fixation with decompression, 4.4%, and (4) removal of implant. 0.33%. The onset of infection sign was divided into 3 groups: (1) acute (< 2 weeks), 43.3%, (2) subacute (2-4 weeks), 40%, and (3) chronic (> 4 weeks), 16.6%. In 11 patients with deep wound infection, no bacteria was cultured, while 14 patients had Methicillin-resistant Staphylococcus aureus and another 3 patients had lower-grade toxic Staphylococcus aureus. All patients received debridement followed by delayed wound closure with effective antibiotics. Instruments were removed in only 8 patients. Twenty seven cases were cured after treatment but 3 patients expired in poor condition. CONCLUSIONS In this series, total deep wound infection was 0.9% in our 6-year experience. The incidence of postoperative spinal infection increased with the complexity of the procedure. Most patients got completely disease free with antibiotics and surgical treatment.