Long-term clinical and biomechanical impact of surgical site infection after thoracolumbar fusion for adult spinal deformity: Retrospective analysis of 124 patients with more than 3 years of follow-up - 15/10/25
Abstract |
Background |
Postoperative surgical site infection (SSI) is a feared complication after posterior thoracolumbar fusion. While management of SSI have been described, its mechanical and clinical impact during the follow-up of posterior thoracolumbar fusion for the management of adult spinal deformity is still imperfectly known.
Hypothesis |
We formulate in this study the hypothesis that occurrence of an SSI during the follow-up of posterior thoracolumbar fusion for the management of adult spinal deformity would have mechanical consequences but not necessarily clinical impact at last follow-up.
Patients and methods |
This study is a retrospective analysis of a prospective single-center database. A total of 124 patients (mean age: 64.8 years) with a mean follow-up period of 3.1 years were included.
The analysis included patients who underwent long posterior fixation (>5 levels), including the lumbosacral junction, for spinal deformity correction. Patient demographics and complications were analyzed. In cases of deep SSI, patients underwent surgical revision with debridement and broad-spectrum antibiotic therapy.
Patient outcomes were evaluated using the Oswestry Disability Index (ODI), the visual analog scale for lumbar pain (VAS-L), and radicular pain (VAS-R) at baseline and final follow-up. Two subgroups were then compared analysis: patients with a postoperative SSI and patients free of infection.
Results |
On the whole series, the average number of instrumented vertebral levels was 11.7 (range: 6–18). Deep SSI occurred in 25 patients (20%), with an average onset of 0.4 months postoperatively.
Multivariate analysis did not show a significant impact of SSI on clinical score improvement (ODI, lumbar and radicular VAS). However, mechanical complications analysis revealed a rod breakage rate of 28.0% in infected patients compared to 14.14% in infection-free patients (p = 0.033). The hazard ratio for rod fracture in patients with deep infection was 3.02 ([1.11, 8.22], p < 0.05).
Conclusion |
The occurrence of deep SSI represents a significant risk factor for rod fracture during follow-up. However, it does not significantly impact long-term functional outcomes, such as lumbar or radicular pain improvement. These results may find their interest in patients counselling when a surgical treatment for adult spinal deformity is required.
Level of evidence |
IV; retrospective analysis of a prospective single-center database.
Le texte complet de cet article est disponible en PDF.Keywords : Spine, infection, mechanical impact, clinical scores
Plan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?