| Abstrakt: |
Objective: Despite the successful application of spinal instrumentation surgery, the development of surgical site infections (SSIs) remains inevitable even in the most experienced neurosurgery clinics. The aim of this study was to analyze potential risk factors, reassess diagnosis and treatment, and discuss outcomes in line with the literature. Materials and Methods: The records of 1564 patients who underwent spinal instrumentation surgery between 2016 and 2023 were retrospectively reviewed. Among these patients, 297 developed superficial or deep SSIs in the postoperative period. Diagnosis was based on postoperative positive wound cultures, intraoperative cultures, serum procalcitonin and C-reactive protein (CRP) levels measured in the postoperative period, and gadolinium-enhanced magnetic resonance imaging (MRI) and computed tomography scan. Demographic characteristics and preoperative risk factors of the patients were analyzed. Results: SSIs were observed in 297 (18.9%) out of 1564 patients who underwent spinal instrumentation surgery. Multiple risk factors for spinal infections following spinal instrumentation surgery, which can manifest in both the early and delayed postoperative periods, were identified. Early diagnosis and prompt initiation of appropriate treatment were associated with better prognosis in 215 patients. Among the 82 patients diagnosed late, all underwent revision surgery for spinal implant removal due to failed medical treatment, with clinical outcomes in 23 of these patients not meeting post-operative expectations. The relationship between early and delayed diagnosis and the need for reoperation were statistically significant (p<0.001). Reoperation was required in 92.7% of patients with delayed diagnosis compared with 15.3% of patients with early diagnosis, indicating an approximately 11.6-fold higher risk of reoperation in patients with delayed diagnosis. Conclusion: Intraoperative culture results are the gold standard for diagnosing SSIs after spinal instrumentation surgery and are also valuable for selecting antimicrobial agents. Monitoring procalcitonin and CRP levels, along with MRI, is highly beneficial for diagnosis. Early detection requires fewer surgical interventions and improves clinical outcomes. [ABSTRACT FROM AUTHOR] |
