Are you planning to have neck or back surgery in the near future? If so, you've likely already started preparing for the event and its outcomes. Along with the logistics of undergoing the procedure itself, there are other factors to consider, including: healing time, the need to adjust to a less active lifestyle (at least for a while), any rehab or physical therapy your doctor may prescribe, and much more.
Another thing to add to this list of concerns is the potential for a post-operative infection. A post-operative infection, also known as a "wound infection" or "spinal infection," is a complication of surgery that occurs in up to 20% of cases, although many experts say the incidence is about 2.5% to 3%.
Post-operative infections can be very serious, so surgeons tend to be vigilant about monitoring their patients after a procedure. Should an infection occur, treatment is often aggressive. “Spine infections are potentially serious and should be respected as such,” says Dr. Andrew Sama, orthopedic surgeon at the Hospital for Special Surgery in New York, adding that “a high index of suspicion and aggressive management are key to a successful outcome.”
What Causes Post Operative Spinal Infection?
Some of the responsibility for preventing a post-surgical spinal infection is yours, while some falls on your doctor and the hospital. Researchers from the University of Pennsylvania reviewed a 19-year span of medical studies on the risks of, and treatments for, spinal infection. The review, published in the April 2010 issue of Spine Journal, concluded that the risk of infection is “multi-factorial” and due to “complex interplay of patient and procedural influences.”
Chia-Hsiao and associates, researchers who reviewed cases of infections occurring after spinal surgery at a Chinese hospital over a 6-year period, looked at a total of 3,230 patients, and found 72 cases of infection. The patients in the study needed surgery for a variety of reasons, including stenosis, scoliosis, spinal fracture, revision surgery and more.
The Chinese researchers identified 3 main factors that play a role in acquiring a wound infection following back surgery: the patient, the environment in which the operation takes place, and the type of spinal procedure used. But researchers did not evaluate the effects of environmental factors on the risk for infection. Following are the researchers' findings, along with insights from other spine experts:
Patient-Related Risk Factors for Infection Following Spinal Surgery
Certain diseases and conditions predispose you to a higher risk for wound infection following back surgery. Some conditions, like obesity and smoking, are related to your lifestyle, while others are medical conditions that your doctor will diagnose. Depending on the condition or disease, you may still have the ability to influence (and decrease) your risk of infection.
According to Chia-Hsiao, these diagnosable diseases and conditions include: hypertension, diabetes, coronary artery disease (CAD), renal disease, cirrhosis of the liver and cancer. Steroid use can also increase your risk, as can a depressed or compromised immune system. According to Dr. Sama, osteoporosis can also increase your risk.
If you already have an infection from a dental or gynecological procedure, for example, you are unfortunately more likely to get another infection.
Age is another risk factor, as is poor nutrition. Chia-Hsiao found that deep wound infections occurred more frequently in older people, who also tended to be more poorly nourished. A related risk factor is obesity, and because obesity is related to your lifestyle, it's a risk factor you can control.
Related: Obesity and Spine Surgery
While we’re on the topic of lifestyle-related risk factors, don’t forget smoking. It's common knowledge that smoking makes healing from a back surgery more difficult, and in some cases it's even responsible for a failed back surgery.
Smoking decreases the blood supply to your tissues, which can increase spinal degeneration, as well as pain, says Dr. Jennifer Solomon, a physiatrist, also from the Hospital for Special Surgery in New York.
“Smokers should stop smoking before and after spine surgery to optimize outcomes,” Sama advises.
Related: How Smoking Affects Your Spine
Procedural Related Risk Factors for Spinal Infection
Complex spine surgery, especially when the operation lasts a long time and/or hardware is placed in your spine, raises your risk for infection. Surgery to correct scoliosis is one example of such a surgery.
Related: What is a Cobb Angle?
“Spine surgeries with long operating times and large amounts of blood loss are risk factors for wound infection,” Sama informs me. Chia-Hsiao found that a greater number of spinal levels operated on during a procedure contributed to a higher risk for wound infection afterwards.
Revision surgery is another lengthy back surgery. It's almost always complex, involving multiple spinal levels, and is at the top of the list of things that increase your risk.
In revision surgery, your structures and tissues have already been compromised by previous surgery or surgeries, so you are more vulnerable, says Dr. Joshua Auerbach, Chief of Spine Surgery, Bronx-Lebanon Hospital Center. Dr. Auerbach is also Assistant Professor of Surgery at the Albert Einstein College of Medicine.
"Every time you have a back surgery," he tells me, "you use up some or all of the available bone that's necessary for successful outcomes."
If you have a medical condition that's not related to your spine, and you're having revision back surgery, this raises the risk even further.
“Revision surgery requiring the use of hardware in diabetic and/or obese patients, or in patients with prior history of infections, is very high-risk,” Sama comments.
What You Can Do For Yourself
While it's unfortunately not possible to guarantee prevention of a post-operative spinal infection, even if you do everything right—it most likely is possible to decrease your risk. If you know you'll be having back surgery soon, doing some lifestyle "therapy" ahead of time may help you avoid a wound infection, for example. For the medical side of things, be sure to consult with your doctor, and to follow her instructions carefully as you plan for prevention.
Auerbach, J., MD. Chief of Spine Surgery, Bronx-Lebanon Hospital Center, Assistant Professor of Surgery, Albert Einstein College of Medicine. Phone Interview. March 2012.
Chia-Hsiao Kuo, Shih-Tein Wang, Wing-Kuang Yu, Ming-Chau Chang, Chien-Lin Liu, Tain-Hsiung Chen. Postoperative Spinal Deep Wound Infection: A Six-year Review of 3230 Selective Procedures. J Chin Med Assoc 2004;67:398-402 http://homepage.vghtpe.gov.tw/~jcma/67/8/398.pdf
Gelalis, ID, Amaoutoglou, CM, Politis, AN, Batzaleksis, NA, Katonis, PG, Xenakis, TA. Bacterial wound contamination during simple and complex spinal procedures. A prospective clinical study.http://www.ncbi.nlm.nih.gov/pubmed/22122837
Gerometta, A., Rodriguez, Olaverri JC, Bitan, F. Infections in spinal implementation. Int Orthop. Feb 2012. http://www.ncbi.nlm.nih.gov/pubmed/22218913
Schuster, JM, Rectine, G, Norvell, DC, Dettori, JR. The influence of perioperative risk and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine. April 2010. http://www.ncbi.nlm.nih.gov/pubmed/20407344.
Sama, Andrew, MD. Orthopedic Surgeon. Hospital for Special Surgery. New York. Email Interview. March 2012.
Solomon, Jennifer MD. Hospital for Special Surgery. New York. Email Interview. Jan 2012.