Failure of Attempted Implant Retention in Spinal Deformity Delayed Surgical Site Infections

Study Design. A retrospective case series. Objective. To determine if implant retention is possible in spinal deformity cases which present as a delayed (greater than 3 months) surgical site infection. Summary of Background Data. The retention of spinal implants in deformity surgery is possible with an acute surgical site infection. Currently, the decision whether or not to retain implants in a delayed surgical site infection is unclear. Methods. A retrospective review of 26 cases of delayed surgical site infections after spinal deformity surgery. Data and information was recorded regarding the initial management of the surgical site infection, the number of operations performed related to the infection, and whether or not the infection could be cleared with implant retention. The number of operations, hospital days, and charges related to the treatment of the infection were recorded. Results. In this series, no patient was able to clear their infection without spinal implant removal. The number of operations required to clear the infection, length of hospitalization, and financial charges were proportionate to the timing of implant removal. Conclusion. Delayed surgical site infections after spinal instrumentation for deformity need to be treated with implant removal to clear the surgical site infection. Patients may require to undergo repeat instrumentation and fusion at a later date if they develop progressive deformity or symptomatic pseudarthrosis after implant removal.