Osteosynthesis and Trauma Care 2004; 12(2): 48-51
DOI: 10.1055/s-2004-822689
Original Article

© Georg Thieme Verlag Stuttgart · New York

Post-Operative Wound Infection after Instrumentation and Fusion of Thoracic and Lumbar Fractures

L. Y. Carreon1 , R. M. Puno1 , S. D. Glassman1 , J. R. Dimar1
  • 1Spine Institute, Louisville, Kentucky, USA
Further Information

Publication History

Publication Date:
05 July 2004 (online)


Infection rates for elective spine surgeries are well established, however, literature on postoperative wound infections following surgeries for thoracolumbar fractures are rare. Unstable fracture and fracture dislocations frequently require instrumentation and fusion over multiple levels or a combined anterior and posterior approach. Subjecting acutely injured patients to these extensive procedures increases the risk of post-operative wound infections. Factors that increase this risk include the administration of steroids, extensive dissection during surgery, prolonged operative times, malnutrition, smoking, advanced age, presence of associated medical conditions and history of prior back surgery.

Treatment in our center for an established post-operative spine infection consists of early exploration, multiple debridements and irrigation with implantation of antibiotic impregnated beads, and prolonged intravenous antibiotic administration. This treatment protocol has allowed us to salvage the instrumentation, with the majority of patients going on to fusion.


  • 1 Abbey D M, Turner D M, Warson J S. et al . Treatment of post-operative wound infections following spinal fusion with instrumentation.  J Spinal Disord. 1995;  8 278-283
  • 2 Blam O G, Vaccaro A R, Vanichkachorn J S, Albert T J, Hilibrand A S, Minnich J M, Murphey S A. Risk factors for surgical site infection in the patient with spinal injury.  Spine. 2003;  28 1475-1480
  • 3 Bracken M B. Steroids for acute spinal cord injury. Cochrane Database Syst Rev 2002; 3: CD001046
  • 4 Bracken M B, Shepard M J, Holford T R. et al . Administration of methylprednisolone for 24 or 48 hours or tririlazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Study.  JAMA. 1997;  277 1597-1604
  • 5 Bristrian B, Blackburn G, Hallowell E. et al . Protein status of general surgical patients.  JAMA. 1974;  230 856
  • 6 Calderon R R, Garland D E, Capen D A. et al . Cost of medical care for postoperative spinal infections.  Orthop Clin North Am. 1996;  27 171-182
  • 7 Capen D, Calderon R, Green A. Perioperative risk factors for wound infections after low back fusions.  Clin Orthop. 1996;  27 83
  • 8 Dickhaust S, DeLee J, Page C. Nutritional status: Importance in predicting wound healing in amputations.  J Bone Joint Surg [Am]. 1984;  66 71
  • 9 Glassman S D, Dimar J R, Puno R M, Johnson J R. Salvage of instrumented lumbar fusions complicated by surgical wound infection.  Spine. 1996;  221 2163-2169
  • 10 Heller J G, Garfin S R. Postoperative infection of the spine.  Sem Spine Surg. 1990;  2 268-282
  • 11 Jensen J, Jensen T, Smith T. et al . Nutrition in orthopedic surgery.  J Bone Joint Surg [Am]. 1982;  64 1263
  • 12 Keller R B, Pappas A M. Infection after spinal fusion using internal fixation instrumentation.  Orthop Clin North Am. 1972;  3 99-111
  • 13 Klein J, Garfin S. Nutritional status in the patient with spinal infection.  Clin Orthop. 1996;  27 33-36
  • 14 Lind J, Kramhoft M, Bodtker S. The influence of smoking on complications after primary amputations of the lower extremity.  Clin Orthop. 1991;  267 211-217
  • 15 MacBurney M, Wilmore D W. Rational decision making in nutritional care.  Surg Clin North Am. 1981;  61 571
  • 16 McAfee P, Bohlman H. Complications following Harrington instrumentation for fractures of the thoracolumbar spine.  J Bone Joint Surg [Am]. 1985;  67 672-686
  • 17 Porties S E, Gamelli R L, Mead P B. et al . The epidemiologic features of nosocomial infections in patients with trauma.  Arch Surg. 1991;  126 97-99
  • 18 Rechtine G R, Bono P L, Cahill D, Bolesta M J, Chrin A M. Postoperative wound infection after instrumentation of thoracic and lumbar fractures.  J Orthop Trauma. 2001;  15 566-569
  • 19 Shen W J, Liu T J, Shen Y S. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit.  Spine. 2001;  26 1038-1045
  • 20 Sorensen L T, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized clinical control trial.  Ann Surg. 2003;  238 1-5
  • 21 Stolke D, Sollman W P, Selfert V. Intra- and postoperative complications in lumbar disc surgery.  Spine. 1989;  14 56-59
  • 22 Thalgott J S, Cotler H B, Sasso R C, LaRocca H, Gardner V. Postoperative infections in spinal implants. Classification and analysis - A multicenter study.  Spine. 1991;  16 981-984
  • 23 Wimmer C, Gluch H. Management of postoperative wound infection in posterior spinal fusion with instrumentation.  J Spinal Disord. 1996;  9 505-508

L. Y. CarreonMD 

Spine Institute

210 E. Grey Street, Suite 900

Louisville, KY 40202


Phone: +1/5 02-5 84-75 25

Fax: +1/5 02-5 84-68 51

Email: LCarreon@SPINEMDS.com