SPINAL implant infections (SIIs) are a severe complication of instrumented spinal fusion surgeries, posing significant challenges for both diagnosis and management. These infections, although uncommon, carry high morbidity, affecting patient outcomes and healthcare systems alike due to prolonged treatments and complex surgical interventions.
According to a newly published state-of-the-art review, early detection and targeted management are critical for improving patient outcomes. SIIs often present in the early postoperative period with symptoms such as wound-healing issues, back pain, and fever. MRI remains the diagnostic tool of choice; however, its utility can be hampered by metal artifacts from the implants, complicating accurate detection.
Treatment strategies depend on the timing and severity of the infection. For cases with stable implants, surgical debridement combined with implant retention and a minimum of 12 weeks of antibiotics is recommended. Staphylococcal infections, a common cause of SIIs, benefit from biofilm-active antibiotics to ensure effective treatment. In cases where surgical debridement is delayed or incomplete, suppressive antibiotic therapy may be considered, especially for patients who are not candidates for further surgery.
Chronic SIIs often present more subtly, with signs such as implant failure or pseudarthrosis. For these cases, implant removal or revision surgery is typically pursued to address the underlying issue. The review highlights that current treatment protocols heavily rely on data extrapolated from periprosthetic joint infection (PJI) literature, given the limited high-quality studies specific to spinal implants.
The authors emphasize the urgent need for further research to refine diagnostic tools and optimize treatment strategies for SIIs. By integrating multidisciplinary expertise, healthcare professionals can provide more effective care and reduce the burden of these challenging infections.
As spinal fusion surgeries remain a cornerstone in managing various spinal disorders, staying informed about advancements in SII management is essential for healthcare providers. This review serves as a vital resource for improving outcomes in patients affected by these complex infections.
Reference: Tai DBG et al. State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections. Clin Infect Dis. 2024;79(6):e65-e71.
Anaya Malik | AMJ
