Bürger Justus, Palmowski Yannick, Pumberger Matthias
Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.
J Spine Surg. 2020 Dec;6(4):793-799. doi: 10.21037/jss-20-497.
Postoperative spinal implant infection (PSII) is a commonly found and serious complication after instrumented spinal surgery. Whereas early-onset PSII usually can be diagnosed by clinical symptoms, the diagnosis of late-onset PSII can be often made only by examination of intraoperatively collected samples. The treatment of PSII consists of surgical and antibiotic therapy schemes. In case of early PSII, the retention of spinal implants is a feasible option, whereas late PSII is usually treated by one-staged exchange of the spinal implants. Radical debridement of surrounding tissue should be performed in any case of PSII. The antibiotic treatment depends on either the implants can be removed or need to be retained or exchanged, respectively. If the causative pathogens are sensitive for biofilm-active antibiotic agents, the duration of antibiotic treatment amounts to 12 weeks with retention of spinal implants. In case of problematic pathogens, the application of antibiotics needs to be prolonged for an individual duration. Antibiotic treatment should always be initiated with an intravenous application for at least 2 weeks.
术后脊柱植入物感染（PSII）是脊柱器械手术后常见且严重的并发症。早发性PSII通常可通过临床症状诊断，而迟发性PSII往往只能通过检查术中采集的样本才能确诊。PSII的治疗包括手术和抗生素治疗方案。对于早发性PSII，保留脊柱植入物是一种可行的选择，而迟发性PSII通常通过一期更换脊柱植入物进行治疗。无论何种情况的PSII，都应彻底清创周围组织。抗生素治疗取决于植入物能否取出，还是需要保留或更换。如果致病病原体对生物膜活性抗生素敏感，保留脊柱植入物时抗生素治疗疗程为12周。对于有问题的病原体，抗生素应用需要延长至个体化疗程。抗生素治疗应始终先静脉应用至少2周。
