An Assessment of the Safety of Surgery and Hardware Placement in de-novo Spinal Infections. A Systematic Review and Meta-Analysis of the Literature.

Publication Title

Global Spine J

Authors

Jonathan Pluemer, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
Yevgeniy Freyvert, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Nathan Pratt, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Jerry E Robinson, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Jared A Cooke, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Zachary L Tataryn, Spine Department, Swedish Neuroscience Institute, Seattle, WA 98122, USAFollow
Periklis Godolias, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
Zeyad A Daher, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Rod J Oskouian, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Jens R Chapman, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow

Document Type

Article

Publication Date

12-12-2022

Keywords

washington; swedish; swedish neurosci; de novo; discitis; epidural abscess; osteomyelitis; pyogenic infection; spinal infection; spine; treatment

Abstract

OBJECTIVES: Primary objectives were outcomes comparison of instrumented surgery used for de-novo spinal infections in terms of infection recurrence, reoperations, primary failure, mortality, and length of stay relative to non-instrumented surgery. Secondary objectives were outcomes for surgical and non-surgical treatment of de-novo spinal infections regarding recurrence of infection, mortality, quality of life, and length-of-stay.

METHODS: A systematic literature review was performed using the PubMed database. Studies comparing outcome variables of patients with de-novo spinal infections (DNSI) treated with and without instrumentation and surgical versus non-surgical treatment were included. Studies primarily focusing on epidural abscesses or non-de-novo infections were excluded. A meta-analysis was performed for infection recurrence, reoperation, primary treatment failure, mortality, and quality-of-life parameters.

RESULTS: A total of 17 retrospective studies with 2.069 patients met the inclusion criteria. 1.378 patients received surgical treatment with or without instrumentation; 676 patients were treated non-surgically. For the comparison of instrumented to non-instrumented surgery Odds-Ratios were .98 (P = .95) for infection recurrence, .83 (P = .92) for primary failure, .53 (P = .02) for mortality and .32 (P = .05) for reoperation. For the comparison of non-surgical to surgical treatment, Odds-Ratios were .98 (P = .95) for infection recurrence, and 1.05 (P = .89) for mortality.

CONCLUSION: Available data support that instrumented surgery can be performed safely without higher rates of infection recurrence or primary failure and lower reoperation and mortality rates compared to nonsurgical treatment for DNSI. Furthermore, spine surgical treatment may generally be performed without higher risk of infection recurrence and mortality and better quality-of-life outcomes compared to generic non-surgical treatment.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Surgery