Adjacent segment infection after posterior lumbar fusion surgery

Abstract Study Design: Retrospective study. Objectives : Adjacent segment infection after posterior lumbar fusion for noninfectious spinal surgery is rare. The incidence, etiology, and treatment of adjacent segment infections are rarely reported, and the objective of this study was to investigate the incidence, risk factors, diagnosis, and treatment of adjacent segment infection(ASI) in patients undergoing posterior lumbar fusion surgery for noninfectious spinal surgery. Methods : This retrospective study included patients who underwent lumbar decompression fusion surgery for the treatment of noninfectious lumbar spine diseases between 2008–2020. Clinical data collected from the First People’s Hospital of Yunnan Province included sex, age, comorbidities, visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and adjacent segment infections (ASIs). Results : A total of 6,325 patients undergoing posterior lumbar fusion surgery for noninfectious spinal surgery met the inclusion criteria. Seven patients (0.11%) developed ASIs. Five patients underwent posterior debridement, autologous iliac bone grafting, and prolonged internal fixation. Two patients were cured with combined anti-infectious therapy. Before the operation, the VAS score was 8.57 ± 0.98, the ODI score was 42.86 ± 3.85, the last follow-up VAS score was 2.0 ± 0.82, and the ODI score was 13.29 ± 2.92. At the last follow-up, all patients had an ASI segment that achieved bony fusion, and posterior lumbar fusion surgery for noninfectious lumbar spine diseases was associated with a 0.11% risk of ASI. Conclusions : Surgeons should be aware of the risk factors for site infection to be able to avoid its occurrence. Early diagnosis is based on the patient's symptoms, signs, laboratory tests, MRI examination.Timely application of sensitive antibiotics, intervertebral space debridement, autologous iliac bone graft fusion, and prolonged internal fixation are effective treatment measures.