Background: Minimally invasive surgery (MIS) has shown the potential in reducing surgical site infection (SSI); however, its impact on instrumented lumbar fusion procedures remains unclear. Purpose: We sought to investigate the difference in SSI rates for open, mini-open, and MIS techniques in patients who underwent posterior lumbar instrumented fusions. Methods: We conducted a retrospective review of all patients at a single academic institution who underwent instrumented 1- or 2-level posterior lumbar fusion between January 2019 and June 2022. Cases were allocated to 1 of 3 mutually exclusive surgical cohorts (MIS, mini, or open). SSIs were diagnosed based on the National Healthcare Safety Network criteria. Results: A total of 1352 patients were reviewed for a total of 1382 lumbar fusion operations included in this study. The mean age was 61.5 ± 12.8 years, and the mean body mass index was 28.7 ± 5.67 kg/m2. The largest cohort was open (39.3%, 543), followed by mini (33.1%, 458) and MIS (27.6%, 381). Thirteen patients (0.94%) developed an SSI. There were no statistically significant differences in the infection rates between the cohorts; SSI rates were MIS (0.3%, 1), mini (1.1%, 5), and open (1.3%, 7). Twelve (92%) of the patients with an SSI underwent a subsequent irrigation and debridement procedure; on average, this occurred 42.2 ± 25 days postoperatively. Conclusions: This retrospective review found that 0.94% of patients developed an SSI following a 1- or 2-level posterior lumbar instrumented fusion. Although the observed SSI rate in the open cohort was 4 times higher than in the MIS cohort, the sample sizes were insufficient to determine statistically significant differences between the 3 surgical approaches. Nonetheless, our data suggests that all 3 techniques evaluated had exceptionally low infection rates.
AndersonPASavageJWVaccaroAR, et al. Prevention of surgical site infection in spine surgery. Neurosurgery. 2017;80(3S):S114–S123. https://doi.org/10.1093/neuros/nyw066
2.
Berríos-TorresSIUmscheidCABratzlerDW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–791. https://doi.org/10.1001/jamasurg.2017.0904
3.
Centers for Disease Control and Prevention. National Health Safety Network. Chapter 9. Surgical site infection (SSI) event. In: Patient Safety Component Manual, January2023. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed November 12, 2023.
4.
Centers for Disease Control and Prevention. National Health Safety Network. Chapter 17. CDC/NHSN surveillance definitions for specific types of infections. In: Patient Safety Component Manual, 2023. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Accessed November 12, 2023.
5.
CizikAMLeeMJMartinBI, et al. Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am. 2012;94(4):335–342. https://doi.org/10.2106/JBJS.J.01084
6.
EeWWGLauWLJYeoWVon BingYYueWM. Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery?. Clin Orthop Relat Res. 2014;472(6):1718–1724. https://doi.org/10.1007/s11999-013-3158-5
7.
GandeARosinskiACunninghamTBhatiaNLeeYP.Selection pressures of vancomycin powder use in spine surgery: a meta-analysis. Spine J. 2019;19(6):1076–1084. https://doi.org/10.1016/j.spinee.2019.01.002
8.
HartRACabaloABessS, et al. Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery. Spine. 2013;38(9):732–736. https://doi.org/10.1097/BRS.0b013e31827ae242
9.
KhanSAChoudryUSalimANathaniKREnamSAShehzadN.Current management trends for surgical site infection after posterior lumbar spinal instrumentation: a systematic review. World Neurosurg. 2022;164:374–380. https://doi.org/10.1016/j.wneu.2022.05.138
10.
KimCHEasleyKLeeJS, et al. Comparison of minimally invasive versus open transforaminal interbody lumbar fusion. Global Spine J. 2020;10(2 suppl):143S–150S. https://doi.org/10.1177/2192568219882344
11.
KimJHAhnDKKimJWKimGW.Particular features of surgical site infection in posterior lumbar interbody fusion. Clin Orthop Surg. 2015;7(3):337–343. https://doi.org/10.4055/cios.2015.7.3.337
12.
KulkarniAGPatelRSDuttaS.Does minimally invasive spine surgery minimize surgical site infections?. Asian Spine J. 2016;10(6):1000–1006. https://doi.org/10.4184/asj.2016.10.6.1000
13.
LiZLiuPZhangC, et al. Incidence, prevalence, and analysis of risk factors for surgical site infection after lumbar fusion surgery: ≥2-year follow-up retrospective study. World Neurosurg. 2019;131:e460–e467. https://doi.org/10.1016/j.wneu.2019.07.207
14.
LiuJMDengHLChenXY, et al. Risk factors for surgical site infection after posterior lumbar spinal surgery. Spine. 2018;43(10):732–737. https://doi.org/10.1097/BRS.0000000000002419
15.
LiuWCYingHLiaoWJ, et al. Using preoperative and intraoperative factors to predict the risk of surgical site infections after lumbar spinal surgery: a machine learning-based study. World Neurosurg. 2022;162:e553–e560. https://doi.org/10.1016/j.wneu.2022.03.060
16.
McGirtMJParkerSLLernerJEngelhartLKnightTWangMY.Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. J Neurosurg Spine. 2011;14(6):771–778. https://doi.org/10.3171/2011.1.SPINE10571
17.
MeredithDSKeplerCKHuangRCBrauseBDBoachie-AdjeiO.Postoperative infections of the lumbar spine: presentation and management. Int Orthop. 2012;36(2):439–444. https://doi.org/10.1007/s00264-011-1427-z
18.
MobbsRJPhanKMalhamGSeexKRaoPJ.Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2–18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05
19.
MokJMGuillaumeTJTaluU, et al. Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine. 2009;34(6):578–583. https://doi.org/10.1097/BRS.0b013e31819a827c
20.
MuellerKZhaoDJohnsonOSandhuFAVoyadzisJM.The difference in surgical site infection rates between open and minimally invasive spine surgery for degenerative lumbar pathology: a retrospective single center experience of 1442 cases. Oper Neurosurg. 2019;16(6):750–755. https://doi.org/10.1093/ons/opy221
21.
OlsenMAMayfieldJLauryssenC, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg. 2003;98(2 suppl):149–155.
22.
O’TooleJEEichholzKMFesslerRG.Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11(4):471–476. https://doi.org/10.3171/2009.5.SPINE08633
23.
ParkYHaJW.Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine. 2007;32(5):537–543. https://doi.org/10.1097/01.brs.0000256473.49791.f4
24.
ParkerSLAdogwaOWithamTFAaronsonOSChengJMcGirtMJ.Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg. 2011;54(1):33–37. https://doi.org/10.1055/s-0030-1269904
25.
PengXQSunCGFeiZGZhouQJ.Risk factors for surgical site infection after spinal surgery: a systematic review and meta-analysis based on twenty-seven studies. World Neurosurg. 2019;123:e318–e329. https://doi.org/10.1016/j.wneu.2018.11.158
26.
PhanKRaoPJKamACMobbsRJ.Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017–1030. https://doi.org/10.1007/s00586-015-3903-4
27.
Rodríguez-VelaJLobo-EscolarAJoven-AliagaE, et al. Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Eur Spine J. 2009;18(8):1194–1201. https://doi.org/10.1007/s00586-009-1010-0
28.
SchusterJMRechtineGNorvellDCDettoriJR.The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine. 2010;35(9 suppl):S125–S137. https://doi.org/10.1097/BRS.0b013e3181d8342c
29.
SheaGKH. Drain blockage by topical vancomycin powder—a case report of a potentially catastrophic complication in spine surgery. J Spine Surg. 2023;9(3):369–374. https://doi.org/10.21037/jss-23-46
30.
SimchenESteinHSacksTGShapiroMMichelJ.Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients. J Hosp Infect. 1984;5(2):137–146. https://doi.org/10.1016/0195-6701(84)90117-8
31.
SkovrljBGilliganJCutlerHSQureshiSA.Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015;3(1):1–9. https://doi.org/10.12998/wjcc.v3.i1.1
32.
SponsellerPDLaPorteDMHungerfordMWEckKBridwellKHLenkeLG.Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine. 2000;25(19):2461–2466. https://doi.org/10.1097/00007632-200010010-00007
33.
SubramanianTAraghiKSivaganesanA, et al. Ambulatory lumbar fusion: a systematic review of perioperative protocols, patient selection criteria, and outcomes. Spine. 2023;48(4):278–287. https://doi.org/10.1097/BRS.000000000000451
34.
TsutsumimotoTShimogataMOhtaHMisawaH.Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine. 2009;34(18):1923–1928. https://doi.org/10.1097/BRS.0b013e3181a9d28e
35.
VaishnavASOthmanYAVirkSSGangCHQureshiSA.Current state of minimally invasive spine surgery. J Spine Surg. 2019;5(suppl 1):S2–S10. https://doi.org/10.21037/jss.2019.05.02
36.
ValentiniLGCasaliCChatenoudLChiaffarinoFUberti-FoppaCBroggiG.Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery. 2008;62(1):88–95; discussion 95–96. https://doi.org/10.1227/01.NEU.0000311065.95496.C5
37.
Van HalMLeeJLaudermilchDNwasikeCKangJ. Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg. 2017;30(8):E1062–E1065. https://doi.org/10.1097/BSD.0000000000000516
38.
WangTYBackAGHompeEWallKGottfriedON.Impact of surgical site infection and surgical debridement on lumbar arthrodesis: a single-institution analysis of incidence and risk factors. J Clin Neurosci. 2017;39:164–169. https://doi.org/10.1016/j.jocn.2017.01.020
39.
XingDMaJXMaXL, et al. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2013;22(3):605–615. https://doi.org/10.1007/s00586-012-2514-6
40.
ZhouJWangRHuoXXiongWKangLXueY.Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine. 2020;45(3):208–216. https://doi.org/10.1097/BRS.0000000000003218
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
