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Mechanisms and treatment of postoperative wound infections in instrumented spinal surgery

Purpose of review Patients undergoing spinal surgery with placement of instrumentation are at an increasing risk of developing a postoperative infection. This review identifies the mechanisms and treatment options for postoperative infections in the spine, and how to achieve a reduced incidence. Recent findings The incidence of postoperative surgical site infection in the thoracolumbar spine continues to be relatively low. Certain patients have, however, been identified as having an increased risk of attracting a postoperative infection despite meticulous technique and advanced antibiotics. Patients with diabetes, obesity and trauma are especially at risk and preoperative and postoperative serum glucose control should be a priority. The primary route for infection is direct inoculation of the open wound during surgery, and strategies to reduce intraoperative contamination have been shown to reduce postoperative wound problems. Surgical site infection with hardware in place should have aggressive open debridement and high volume irrigation. The removal of instrumentation is often not required. Summary Postoperative surgical site infection after spinal surgery can potentially be a devastating outcome after a successful operative intervention. The key in management is prevention and modification of known risk factors as well as aggressive debridements when an infection has been identified.