• Dennis Hey Hwee Weng HW *University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore †Saw Swee Hock School of Public, Nathaniel Ng Li Wen LW, Chuen Seng Tan, Dale Fisher, Anupama Vasudevan, Ka-Po Gabriel Liu, Joseph Shantakumar Thambiah, Naresh Kumar, Leok-Lim Lau, Hee-Kit Wong, and Paul Anantharajah Tambyah.
• *University Orthopedics, Hand and Reconstructive Microsurgery Cluster National University Health System, Singapore †Saw Swee Hock School of Public Health, National University of Singapore, Singapore ‡Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
• Spine. 2017 Apr 15; 42 (8): E490-E495.

Study DesignA retrospective, cohort study of 84 patients with deep spine infection managed at a major tertiary hospital over 14 years with a minimum follow up of 2 years.ObjectiveTo determine the role of instrumentation in spines with deep infection.Summary Of Background DataIt is often believed that implants should not be inserted in patients with deep spine infection because of the risk of persistent or recurrent infection. However, there are often concerns about spinal stability and a paucity of evidence to guide clinical practice in this field.MethodsWe compared the mortality, reoperation, and reinfection rates in patients with spine infection treated with antibiotics alone, antibiotics with debridement, and antibiotics with debridement and instrumentation. Significant outcome predictors were determined using multivariable logistic regression model.ResultsForty-nine males and 35 females with a mean age was 62.0 years had spine infection affecting the lumbar spine predominantly. The most common form of infection was osteomyelitis and spondylodiscitis (69.4%). Staphylococcus aureus was the most common causative organism (61.2%).There was no difference in terms of reoperation or relapse for patients treated with antibiotics alone, antibiotics with debridement, or antibiotics with debridement and instrumentation. However, compared with antibiotics alone, the crude inhospital mortality was lower for patients treated with instrumentation (odds ratio, OR, 0.82; P = 0.01), and antibiotics with debridement (OR 0.80; P = 0.02).ConclusionSpinal instrumentation in an infected spine is safe and not associated with higher reoperation or relapse rates. Mortality is lower for patients treated with instrumentation.Level Of Evidence3.

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