Implant infection after spinal fusion correlated with pedicle screw loosening, ongoing pain

Issue: September 2018

Investigators found implant infections are correlated with pedicle screw loosening and ongoing pain that can lead to the need for revision surgery after spinal fusion.

Researchers identified 110 who underwent revision surgery after an open spinal fusion with metal explantation from thoracic and lumbar spine. Investigators performed an intraoperative infection screening from wound and explanted material sonication during the revision surgery after dorsal stabilization. Independent factors of pedicle screw loosening were identified with multivariate logistic regression analysis.

Results from the infection screening identified a Staphylococcus and Propionibacterium genus germ in 29.1% of the revision cases. A significantly higher number of previous spinal surgeries and radiographic pedicle screw loosening was seen in patients who screened positive. A significantly lower rate of positive infection screening was seen in patients who were revised for adjacent segment failure compared with those who were revised for directly implant related reasons. Investigators noted implant removal showed positive screening at revision surgery led to significant pain relief 1-year postoperatively.

“As clinical presentation of chronic infection is very unspecific prior to revision surgery of failed

spinal fusion, radiographic screw loosening characteristics and multiple prior operations should be suspicious for deep implant infection,” the investigators wrote. “Based on our data, we recommend evaluation for implant removal in spinal fusion cases with chronic, unspecific back pain especially when radiologic loosening signs are present.” – by Monica Jaramillo

Disclosure s : The authors report no relevant financial disclosures.

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Source:

Leitner L, et al. Eur Spine J. 2018;doi:10.1007/s00586-018-5592-2.