Introduction: This systematic review to determine the fate of spinal implants if the patient develops postoperative wound infection after posterior instrumental fusion in the degenerative spine.
Methods: A systematic review of the English-language literature (published between January 2000 and June 2016) was undertaken to identify articles documenting the management strategy for surgical-site infections after posterior lumbar spinal fusion. Studies on Pedicle screw fixation after trauma, immunocompromised. Metastatic spine disease, combined Anterior /posterior approach were excluded. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and evaluation criteria, and disagreements were resolved by consensus.
Results: Out of the 2997 citations identified, 25 met the criteria to undergo full-text review. Outcomes after surgical site infections were studied from the combined pool of 862 patients’ undergone instrumental spinal fusion. 66.73% of the studies supported the idea of implant retention after surgical site infection (Combined OR 0.163 n=523 patients). Wound debridement was the most successful strategy for the salvage of prosthesis (67.2% n=323patients |16 studies) followed by VAC therapy (P<0.05). Most reported factor attributed in implant removal was surgical site infection refractory to wound debridement (CI 95%).
Conclusions: Our review of the literature suggests that successful eradication of surgical site infection after posterior lumbar spinal fusion can be achieved by wound debridement or VAC therapy with appropriate antimicrobial coverage in the majority of the cases. Implant removal is generally reserved for cases refractory to aforementioned treatment modalities.
Patient Care: It is the one of its kind systematic review about the all the researches already conducted.
Learning Objectives: The objective of this systematic review to determine the fate of spinal implants if the patient develops postoperative wound infection after posterior instrumental fusion in the degenerative spine.