Infection of the spine may occur spontaneously, by direct hematogenous or contiguous spread from an area of infection, or secondarily to an inciting event such as trauma or spine operation. The overall rate of spine surgery has increased steadily over the last decade. Medicare spending on inpatient spine surgery has doubled over the same period with lumbar fusion representing the greatest percentage of spending.1 Surgical site infection (SSI) after spinal surgery is not uncommon, leading to increased morbidity and mortality. The incidence of surgical site infection after spine surgery varies and depends on several factors including immune status of patient, surgical level, use of instrumentation and use of prophylactic antibiotic treatment. Multivariate logistic regression analysis identifies increased age of patient, long-term systemic use of steroids, insulin dependent diabetes, obesity, positive smoking status, preoperative hematocrit, disseminated cancer, fusion and operative duration as statistically significant predictors of postoperative infection.2–4 The incidence of SSI is less than 3% with simple procedures such as decompressive laminectomy and/or diskectomy but the incidence increases to as high as 12% with the addition of instrumentation.5 The time of presentation of SSI can range from a couple of days post-surgery to several years after surgery.

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