To describe the success rate of surgical debridement and primary closure without implant removal in the treatment of postoperative spinal wound infections with instrumentation.

One thousand four hundred fifty two posterior instrumented fusions were performed between 2000 and 2006. A retrospective record review identified 63 cases with acute (< 6 weeks) postoperative infection (4.6%). The preoperative diagnosis included fracture (24), adolescent idiopathic scoliosis (4), stenosis/degenerative spondylolisthesis (24), adult deformity (4), neuromuscular scoliosis (3), tumor (2), cervical myelopathy (2). All patients were treated with irrigation – debridement and closed suction drainage placement. Cultures were obtained, all wounds closed primarily and appropriate intravenous antibiotic treatments were initiated. The treatment protocol dictated the appropriate time to discontinue drains and antibiotics. The follow-up period ranged from 6 to 24 months.

The majority of infections occurred during the early postoperative period (less than 2 weeks). Fifty-six (89%) resolved without recurrence with only one surgical debridement. Seven patients (11%) required a second operation for irrigation and debridement. Two patients (3%) required implant removal.

Aggressive surgical treatment of postoperative spinal infections is essential for successful outcomes. Removal of implants is not necessary in acute infections. Delayed wound closure or second look operation could be avoided since primary closure offers accepted success rate.

PURPOSE: To record our experience in surgical treatment of thoracic spine fractures with posterior stabilization, decompression and ligamentotaxis.

MATERIALS AND METHODS: From January 2000 until July 2006, 67 patients (48 males and 19 females), aged 16 to 85 years old (average 41,2 y.o) were surgically treated in our department due to thoracic spine fractures. Preoperative X-Ray and CT scan were used in all cases while in most of the cases we performed MRI to further evaluate the damage. In all cases we performed decompression and posterior stabilization using four different hardware types and whenever possible ligamentotaxis. Continuous electrophysiological monitoring was alo ued in all operations. We recorded the pre- and postoperative neurological status, the vertebral height loss, the kyphotic angle and spinal canal occupation. Moreover we recorded the average hospitalization time, the transfusion needs as well as major and minor complications. At the follow-up we measured the loss of correction at 3, 6 and 12 months postoperatively. The follow up ranged from 4 to 48 months.

RESULTS: Neurological damage was recorded in 43 % of the patients. The average preoperative kyphotic angle was 38.2° while the average spinal canal occupation was 29.8 %. The immediate postoperative correction was 16.7 °. During the follow-up we observed small, insignificant loss of correction. There were no major complications.

CONCLUSION: In cases of thoracic spine fractures the surgical treatment with posterior stabilization and ligamentotaxis is offering significant stability and adequate long term results.