Infection rate in 212 consecutive patients treated by minimally invasive lumbar tubular decompression
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Published:
Aug 3, 2020
Keywords:
Minimally invasive surgical procedures, decompression, discectomy, surgical wound infections
Main Article Content
Abstract
Introduction: Surgical site infections (SSI) can lead to prolonged antibiotic treatments, increased hospital stays, and repeated operations. Small incisions and the possibility of avoiding subperiosteal dissection in minimally invasive surgery can minimize the risk of postoperative infections. However, there is a shortage of literature on infections after mini-invasive procedures. Objective: To evaluate retrospectively a series of patients consecutively operated on with minimally invasive technique and the incidence of postoperative infection. Materials and Methods: Patients undergoing posterior lumbar surgery with tubular retractors and microscope in our department between January 2015 and January 2018 were included. The procedures performed included tubular discectomies, lumbar stenosis decompressions, and synovial cyst resections. The incidence of postoperative SSIs was calculated and compared with the literature range for SSI rates. Results: A total of 212 patients underwent non-instrumented surgeries (discectomies, decompressions). The mean age was 62.4 years with a male:female ratio of 1.27:1. Only one patient had SSI, which was diagnosed on day 9 and treated by reoperation, surgical toilet of the wound, and antibiotic therapy. Conclusion: The infection rate was 0.47%. Minimally invasive surgery can significantly reduce the SSI rate and can be an effective tool in minimizing hospital costs.
Level of Evidence: IV
Level of Evidence: IV
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How to Cite
Coombes, N., Galaretto, E., Guyot, J. P., Fernández, N., & Fuster, C. (2020). Infection rate in 212 consecutive patients treated by minimally invasive lumbar tubular decompression. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(3), 192-196. https://doi.org/10.15417/issn.1852-7434.2020.85.3.1014
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Clinical Research
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2. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, et al. Risk factors for surgical site infection in
spinal surgery. J Neurosurg 2003;98(2 Suppl):149-55. https://doi.org/10.3171/spi.2003.98.2.0149
3. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vineyakam P, Berendt T, et al. The diagnosis and
management of infection following instrumented spinal fusion. Eur Spine J 2008;17(3):445-50.
https://doi.org/10.1007/s00586-007-0559-8
4. Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G. Surgical site infections after
elective neurosurgery: a survey of 1747 patients. Neurosurgery 2008;62(1):88-95.
https://doi.org/10.1227/01.NEU.0000311065.95496.C5
5. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection
following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90(1):62-69. https://doi.org/10.2106/JBJS.F.01515
6. Pappou IP, Papadopoulos EC, Sama AA, Girardi FP, Cammisa FP. Postoperative infections in interbody fusion for degenerative spinal disease. Clin Orthop Relat Res 2006;444:120-8.
https://doi.org/10.1097/01.blo.0000203446.06028.b5
7. Friedman ND, Sexton DJ, Connelly SM, Kaye KS. Risk factors for surgical site infection complicating
laminectomy. Infect Control Hosp Epidemiol 2007;28:1060-5. https://doi.org/10.1086/519864
8. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive
index procedures. J Spinal Disord 2000;13(5):422-6. https://doi.org/10.1097/00002517-200010000-00009
9. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 2005;30(12):1460-5. https://doi.org/10.1097/01.brs.0000166532.58227.4f
10. Kanayama M, Hashimoto T, Shigenobu K, Oha F, Togawa D. Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine 2007;6:327-9. https://doi.org/10.3171/spi.2007.6.4.7
11. Shousha M, Cirovic D, Boehm H. Infection rate after minimally invasive noninstrumented spinal surgery based on 4350 procedures. Spine (Phila Pa 1976) 2015;40(3):201-5. https://doi.org/10.1097/BRS.0000000000000690
12. Brodano GB, Martikos K, Lolli F, Gasbarrini A, Cioni A, Bandiera S, et al. Transforaminal lumbar interbody fusion in degenerative disk disease and spondylolisthesis grade I: minimally invasive versus open surgery. J Spinal Disord Tech 2015;28(10):E559-64. https://doi.org/10.1097/BSD.0000000000000034
13. O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery.
J Neurosurg Spine 2009;11(4):471-6. https://doi.org/10.3171/2009.5.SPINE08633
14. Calderone RR, Garland DE, Capen DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am 1996;27(1):171-82. https://pubmed.ncbi.nlm.nih.gov/8539047/
15. Fessler RG, O’Toole JE, Eichholz KM, Perez-Cruet MJ. The development of minimally invasive spine
surgery. Neurosurg Clin N Am 2006;17(4):401-9. https://doi.org/10.1016/j.nec.2006.06.007
16. Ee WW, Lau WL, Yeo W, Von Bing Y, Yue WM. Does minimally invasive surgery have a lower risk of surgical site
infections compared with open spinal surgery? Clin Orthop Relat Res 2014;472(6):1718-24.
https://doi.org/10.1007/s11999-013-3158-5
17. Al-Khouja LT, Baron EM, Johnson JP, Kim TT, Drazin D. Cost-effectiveness analysis in minimally invasive spine
surgery. Neurosurg Focus 2014;36(6):E4. https://doi.org/10.3171/2014.4.FOCUS1449
18. Bible JE, O’Neill KR, Crosby CG, Schoenecker JG, McGirt MJ, Devin CJ. Microscope sterility during spine
surgery. Spine (Phila Pa 1976) 2012;37(/):623-7. https://doi.org/10.1097/BRS.0b013e3182286129