@article{3115488,
    title = "Postoperative infections of the thoracic and lumbar spine - A review of
18 cases",
    author = "Katonis, Pavlos and Tzermiadianos, Michael and Papagelopoulos, and Panayiotis and Hadjipavlou, Alexander",
    journal = "Clinical Orthopaedics and Related Research",
    year = "2007",
    number = "454",
    pages = "114-119",
    publisher = "Lippincott, Williams & Wilkins",
    issn = "0009-921X, 1528-1132",
    doi = "10.1097/01.blo.0000238807.64541.d3",
    abstract = "We retrospectively reviewed 18 consecutive patients (age range, 19-81
years; average age, 55 years) with postoperative infections of the
spine. Postdiscectomy-laminectomy infections confined to the disc space
(n = 2) were treated with percutaneous transpedicle drainage. Open
debridement was performed in patients with an epidural or paraspinal
abscess (n = 3). Infections after posterior instrumentation that
manifested during the first postoperative month were treated with single
(n = 3) or multiple debridements and delayed closure (n = 7), with
preservation of instrumentation. Infections that presented more than 9
months after the initial operation (n = 3) were treated with open
debridement and removal of instrumentation. The minimum followup was 1
year (mean 2 years, range, 1-4 years). Infections in 17 of the 18
patients resolved effectively and one patient with metastatic cancer
died of sepsis. Transpedicle drainage resulted in immediate relief of
back pain. Instrumentation can be retained safely in patients with
infections that manifest during the first month after implantation.
Single surgical debridement is effective in selected cases. After
repeated debridements, the presence of healthy granulation tissue in the
wound and decreasing C-reactive protein activity were associated with
safe and effective wound closure. Despite radiographic evidence of
hardware loosening in infections manifested more than 9 months after
implantation, we removed hardware without destabilizing the spine."
}