Management of Surgical Site Infections in Spine Surgery: A Current Concept Review

Abstract

Background: Surgical sites infections (SSIs) in spine surgeries represent one of the commonest hospital-acquired infections. SSIs refers to infection of surgical wound within 30 days of surgery or one year of implant usage. SSIs portend a huge disease burden with devastating consequences to the patient and the hospital facility with attendant physical and psychological trauma to the patient and it is associated with increase rate of morbidity and mortality. Objective: The aim of this review is to identify factors that predispose a spine patient to SSIs and to highlight the current preventive and management concepts. Methods: We carried out a comprehensive review of literatures, using key words such as surgical site infections, spine surgery, predisposing factors, prevention, diagnosis, treatment, outcomes on search engines of Google Scholar, Scopus and PUBMED. Eligible articles for the review included full length published articles in English which we have access to contents. Results: Twenty-five full length articles were found eligible for the review. In spite of improvement in spine care and surgery, SSIs continue be a source of great concern to the patients, surgeons and healthcare system of any nation. Gram positive organisms are more common than gram negative organisms. The risk factors for SSIs include patient- and surgeon - related factors. Albeit, there is no universally accepted protocol for the prevention and treatment of SSIs in spine surgery. The incidence of SSIs is on the increase worldwide with associated high risk of morbidity, overall decrease in the quality of life and sometimes mortality. The economic burdens of the management of SSI is huge and stressful for every nation. Treating SSIs after spine surgery is daunting as the choice between removing the implants for proper bacteria clearance and the risk of causing spinal instability is a hard nut to crack. Conclusions: Despite the improved surgical technique, protocol on asepsis and role of prophylactic antibiotics in clean spine surgeries, there are still substantial increase in the rate of SSIs. Therefore, prevention is more profitable than the hope of proper treatment.