State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections

• Published in: Clinical infectious diseases 2024-12, Vol.79 (6), p.e65-e71
• Main Authors: Tai, Don Bambino Geno, Patel, Robin, Lovecchio, Francis, Kwee, Thomas, Wouthuyzen-Bakker, Marjan
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Debridement; Humans; Magnetic Resonance Imaging; Prostheses and Implants - adverse effects; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - therapy; Spinal Fusion - adverse effects; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciae436

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed.