Incidence
Decreasing incidence in recent decades most likely attributable to preoperative antibiotics
Risk
Conventional discectomy </= 1%
Fusion 2%
Fusion & instrumentation 5-6%
Instrumentation doubles infection rate in lumbar fusion
Risk factors
Diabetes
Poor nutritional status
Rheumatoid arthritis
Steroid use
History of previous infection
Previous wound irradiation
MRI
Options
Aggressive wound debridement of devitalised tissue with adequate drainage mandatory
- may leave open & packed
- antibiotic loaded beads
- removal of hardware may leave spine unstable