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Spinal infection after vertebral augmentation: a covert complication with serious havoc

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Vertebral augmentation, including percutaneous vertebroplasty (PVP) or kyphoplasty (PKP), is the current least invasive surgical option and has been widely used to treat the painful osteoporotic vertebral compression fractures (OVCF). However, the postoperative infections could be life-threatening, even though they rarely occur. Our studies aim to clarify the causation and outcomes of spinal infections following augmentation and meanwhile to identify the risk factors.

Methods

A retrospective study was conducted on patients with OVCF who underwent PVP or PKP, and were subsequently admitted to our institution with postoperative spinal infection between January 2010 and December 2022. A total of 33 patients were finally included.

Results

The rate of spinal infection after augmentation in our single institute was 0.05% (2/3893). In addition to these 2 patients, the remaining 31 were referred from other hospitals. All 33 patients exhibited elevated inflammatory parameters, 14 patients presented with fever, and 9 patients experienced neurological deficits. Additionally, 29 patients had comorbidity and risk factors. Pathogens were identified in 26 patients, while only 7 patients were examined as culture negative. 27 patients underwent revision surgery and 6 patients only received conservative therapy. Anterior surgery was performed in 2 patients, while posterior surgery was performed in 20 patients. A combined anterior–posterior surgery was performed in 5 patients. At the final follow-up, 18 patients had unrestricted mobility, 10 patients required assistance from crutches or a walker for ambulation, 4 patients needed a wheelchair, and 1 patients died after revision surgery.

Conclusions

Spinal infection after vertebral augmentation is rare, but it cannot be ignored. Surgeons should make every effort to detect the potential preoperative spondylitis or discitis. Once postoperative spinal infection is confirmed, a prompt intravenous antibiotic therapy is warranted. If medication therapy fails, revision surgery involving debridement and spinal reconstruction should be considered.

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Availability of data and materials

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the Second Xiangya Hospital of Central South University for providing patients information. We thank Dr. Kuan Zhang from the University of California, San Francisco, for critically reviewing and language polishment.

Funding

This study was supported by Fundamental Research Funds for the Central Universities of Central South University Foundation (Grant no. 2022ZZTS0260) and Hunan Provincial Innovation Foundation For Postgraduate (Grant no. CX20220342).

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Author notes

  1. Lei Kuang and Jing Li contribute equally to this article.

Authors and Affiliations

  1. Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People’s Republic of China

    Hui Yuan, Yunchao Li, Jingyu Wang, Xiaobin Wang, Guohua Lü, Lei Kuang & Jing Li

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  1. Hui Yuan
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Contributions

HY: writing—original draft; JW: data collection and validation; YL: methodology and data statistics; XW: screening and study participants; GL: supervision and project management; LK and JL: instruction and revision. All authors contributed to the article and approved the submitted version.

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Correspondence to Lei Kuang or Jing Li.

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The study was approved by the Second Xiangya Hospital of Central South University.

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Yuan, H., Li, Y., Wang, J. et al. Spinal infection after vertebral augmentation: a covert complication with serious havoc. Arch Orthop Trauma Surg 144, 1461–1471 (2024). https://doi.org/10.1007/s00402-024-05205-9

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