State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections

Don Bambino Geno Tai, Robin Patel, Francis Lovecchio, Thomas Kwee, Marjan Wouthuyzen-Bakker

Research output: Contribution to journalReview articlepeer-review

Abstract

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed.

Original languageEnglish
Pages (from-to)e65-e71
Number of pages7
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume79
Issue number6
DOIs
Publication statusPublished - 15-Dec-2024

Keywords

  • antimicrobial therapy
  • biofilm
  • implant retention
  • spinal fusion
  • surgical site infection

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