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Incidence and management of surgical site infection in the cervical spine following a transoral approach

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Abstract

Purpose

Transoral approach can accomplish ventral decompression directly. However, surgical site infection (SSI) cannot be ignored. This paper aims to review the prevalence of infection and conduct advice for the treatment of SSI in the cervical spine following the transoral approach.

Methods

A retrospective analysis of patients with SSI after transoral atlantoaxial reduction plate (TARP) surgery was performed. SSI was classified into three kinds according to the modified American CDC criteria.

Results

2.9% (17/581) patients who underwent TARP surgery, experienced SSI, of which five had superficial SSI (SI), eight had deep SSI (DI), and four had organ/space SSI (O/SI). The patients with SI underwent intravenous antibiotic treatment and were ultimately cured. Among the remaining 12 patients with DI and O/SI, 11 underwent reoperation for TARP system removal and subsequently one-stage posterior occipitocervical fixation, and one patient experienced infection two months post-operatively and died without receiving treatment. Among patients who underwent revision surgery, three experienced intracranial infection due to intra-operative dural tears, and continuous lumbar cerebrospinal fluid drainage and intrathecal injection of antibiotics were used as effective and appropriate treatments, with outcomes of one recovery and two deaths. All patients with SSI were begun on intravenous antibiotics with conversion to oral antibiotics.

Conclusions

The incidence of SSI was 2.9% (17/581). Adequate peri-operative preparation, early diagnosis, and appropriate treatment of SSI require further research.

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Funding

This work was supported by ① Military Medical Science and Technology Youth Cultivation Program Incubation Project (NO.19QNP040, Q T); ② the Science and Technology Planning Project of Guangzhou City (NO.201904010349, Q T); ③ PhD projects of Third Military Medical University (NO.JSKT201904, Q T); ④ Army Logistics Research Project of PLA (CLB20J033, Q T); and ⑤ the National Natural Science Foundation of China (81972080, H X). These grants had no role in the design or execution of this study or the reporting of results.

Author information

Authors and Affiliations

  1. The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China

    Hu Chen, Changrong Zhu, Honglei Yi, Xiangyang Ma, Jianhua Wang, Qiang Tu & Hong Xia

  2. Department of Orthopedic, People’s Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China

    Hu Chen, Changrong Zhu, Honglei Yi, Hao Sun, Xiangyang Ma, Jianhua Wang, Kai Zhang, Zenghui Wu, Qingshui Yin, Qiang Tu & Hong Xia

  3. Department of Orthopedic, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

    Fuzhi Ai

Authors
  1. Hu Chen
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  2. Changrong Zhu
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  3. Honglei Yi
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  4. Hao Sun
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  7. Kai Zhang
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  9. Zenghui Wu
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  10. Qingshui Yin
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  11. Qiang Tu
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  12. Hong Xia
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by HC, CZ, and HY. The first draft of the manuscript was written by HC and QT. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Qiang Tu or Hong Xia.

Ethics declarations

Ethics approval

This is an observational study. The General Hospital of Southern Theatre Command Research Ethics Committee has confirmed that no ethical approval is required.

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Informed consent was obtained from all individual participants included in the study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Cite this article

Chen, H., Zhu, C., Yi, H. et al. Incidence and management of surgical site infection in the cervical spine following a transoral approach. International Orthopaedics (SICOT) 46, 2329–2337 (2022). https://doi.org/10.1007/s00264-022-05492-0

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  • DOI: https://doi.org/10.1007/s00264-022-05492-0

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