Incidence and Recurrence of Deep Spine Surgical Site Infections

This systematic review and meta-analysis, encompassing 54 studies (37 comparative, 17 non-comparative) and 209,347 instrumented spinal fusion procedures, determines a pooled deep surgical site infection (SSI) incidence rate and assesses evidence for deep SSI management strategies.

Key Findings

The pooled deep SSI incidence rate post-thoracolumbar spinal surgery is 1.5% (95% CI, 1.1%-1.9%). Up to 25% of patients (95% CI, 16.8%-35.3%) experience persistent infection, necessitating an average of 1.4 additional debridements. Staphylococcus aureus is the most frequently identified infecting organism (46%). Qualitative analysis indicates a trend toward implant retention, particularly in early deep SSI management.

Significance and Relevance

This review underscores the significant burden of deep SSI following instrumented spinal fusion, emphasizing the need for standardized treatment protocols given the recurrence rate and repeat debridement requirements. The observed heterogeneity in management strategies highlights the necessity for large-scale prospective studies to establish evidence-based approaches. For spine surgeons, infectious disease specialists, and healthcare policymakers, this review provides critical insights into the incidence, management challenges, and areas for future research in preventing and treating deep SSI following spinal surgery.