Long-term clinical and biomechanical impact of surgical site infection after thoracolumbar fusion for adult spinal deformity: Retrospective analysis of 124 patients with more than 3 years of follow-up
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Postoperative surgical site infection (SSI) is a feared complication after posterior thoracolumbar fusion. While management of SSI have been described, its mechanical and clinical impact during the follow-up of posterior thoracolumbar fusion for the management of adult spinal deformity is still imperfectly known. HYPOTHESIS: We formulate in this study the hypothesis that occurrence of an SSI during the follow-up of posterior thoracolumbar fusion for the management of adult spinal deformity would have mechanical consequences but not necessarily clinical impact at last follow-up. PATIENTS AND METHODS: This study is a retrospective analysis of a prospective single-center database. A total of 124 patients (mean age: 64.8 years) with a mean follow-up period of 3.1 years were included. The analysis included patients who underwent long posterior fixation (>5 levels), including the lumbosacral junction, for spinal deformity correction. Patient demographics and complications were analyzed. In cases of deep SSI, patients underwent surgical revision with debridement and broad-spectrum antibiotic therapy. Patient outcomes were evaluated using the Oswestry Disability Index (ODI), the visual analog scale for lumbar pain (VAS-L), and radicular pain (VAS-R) at baseline and final follow-up. Two subgroups were then compared analysis: patients with a postoperative SSI and patients free of infection. RESULTS: On the whole series, the average number of instrumented vertebral levels was 11.7 (range: 6-18). Deep SSI occurred in 25 patients (20%), with an average onset of 0.4 months postoperatively. Multivariate analysis did not show a significant impact of SSI on clinical score improvement (ODI, lumbar and radicular VAS). However, mechanical complications analysis revealed a rod breakage rate of 28.0% in infected patients compared to 14.14% in infection-free patients (p = 0.033). The hazard ratio for rod fracture in patients with deep infection was 3.02 ([1.11, 8.22], p < 0.05). CONCLUSION: The occurrence of deep SSI represents a significant risk factor for rod fracture during follow-up. However, it does not significantly impact long-term functional outcomes, such as lumbar or radicular pain improvement. These results may find their interest in patients counselling when a surgical treatment for adult spinal deformity is required. LEVEL OF EVIDENCE: IV; retrospective analysis of a prospective single-center database.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,820
OpenAlex ID: W4415224807