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REVIEW ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 117-121

Surgical management of postoperative infections in spine surgery


Department of Orthopaedics, Spinal Disorders Surgery Unit, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Rohit Amritanand
Department of Orthopaedics, Spinal Disorders Surgery Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/isj.isj_23_17

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Postoperative infections following spine surgery are a devastating complication. They add to morbidity, financial burden, and poor outcomes for a patient. The reported incidence of surgical site infection is variable and depends on a number of factors. Overall, cases that require extensive soft-tissue dissection, higher blood loss, and prolonged operative time lead on to higher rates of infection. Minimally invasive surgeries (MISS) have demonstrated significantly reduced rates of infection. A high index of suspicion and a stepwise approach is required to diagnose this complication. A thorough clinical examination with appropriate blood and radiological investigations confirms the diagnosis. Identification of the offending microorganism is vital as it will guide targeted antibiotic therapy. Once this is done, a course of appropriate antibiotics should be commenced. Surgical strategies are available to patients who do not respond to medical management or who develop neurological deficits. The aim of surgical management is the clearance of infection, soft-tissue closure, and the restoration of spinal column integrity. This is accomplished through meticulous tissue debridement, fluid lavage, and wound closure. The stability of already placed implant should be assessed and if sound should be retained. In cases where wound closure is a challenge, soft-tissue reconstruction techniques may be required. Other options such as vacuum therapy are available. Finally, each member of the health-care team, including the patient, has an important role to play in order to keep the occurrence of this unwanted complication to the lowest possible level.


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