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Routine intraoperative microbiological smear testing in patients with reoperation after elective degenerative non-instrumented spine surgery–useful or negligible adjunct

  • Original Article - Spine - Other
  • Published:
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Abstract

Purpose

Surgical site infections (SSI) are a rare but dreaded cause for recurrent symptomatology requiring reoperation after degenerative spine surgery. We here aim to elucidate if routine microbiological smear testing during reoperation might be a useful tool for subsequent patient management.

Methods

We investigated clinical, laboratory/imaging characteristics, and outcome of patients undergoing reoperation in the previously affected segment during follow-up after elective degenerative non-instrumented spine surgery. Microbiological cultures via multiple intraoperative smear tests of the superficial/deep wound layers were routinely performed and correlated with clinical/imaging/laboratory/surgical signs for SSI and outcome.

Results

From altogether 2552 patients with degenerative spine surgery in 2014–2019, a total of 62 patients (m:f = 1.6:1, median 69 years) underwent same-level reoperation due to recurrent symptomatology (mean ∆-time:17 ± 36 months) with a predominance of the lumbar spine (90%). In 9 patients with imaging/laboratory suspicious for SSI, microbiological culturing of intraoperative smear testing revealed conclusive pathogen growth in 89% (100% with additional PCR analysis); the predominant pathogen was Staphylococcus aureus with detection mainly in the deep wound layers. In contrast, in 53 patients without clinical/imaging/laboratory/intraoperative signs for SSI microbiological culturing showed minor pathogen growth in 15% displaying bacterial colonization/contamination of the surgical site. The predominant pathogens in this cohort were Staphylococcus epidermidis and Cutibacterium acnes, and these patients had favorable outcomes when monitored with close surveillance without anti-infective treatment.

Conclusion

Bacterial colonization/contamination occurs in 15% of patients without signs of infection undergoing same-level reoperation after degenerative spine surgery. These patients can be managed with close surveillance without antibiotic treatment.

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Abbreviations

ACDF:

Anterior cervical discectomy and cage fusion.

BI:

Barthel index.

ca:

Circa.

CRP:

C-reactive protein.

CSF:

Cerebrospinal fluid.

DNA:

Deoxyribonucleic acid.

DWI:

Diffusion-weighted imaging.

IL-6:

Interleukin-6.

MRI:

Magnetic resonance imaging.

NPV:

Negative predictive value.

PCR:

Polymerase chain reaction.

PPV:

Positive predictive value.

resp:

Respectively.

SSI:

Surgical site infection.

VAS-N:

Visual analog scale for axial neck pain.

VAS-R:

Visual analog scale for radiating pain.

WBCC:

White blood cell count.

WHO:

World Health Organization

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Acknowledgements

We are grateful to all patients participating in our study.

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Authors and Affiliations

  1. Clinic, Neurosurgical , University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Sebastian Siller, Raimund Trabold, Stefan Zausinger & Joerg-Christian Tonn

  2. Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Via della Pineta Sacchetti 217, 00168, Rome, Italy

    Benjamin Skrap

  3. Institute for Clinical Infectiology and Hospital Hygiene, Clinic, University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Beatrice Grabein

  4. Neurochirurgie Am Stachus, Karlsplatz 4, 80335, Munich, Germany

    Stefan Zausinger

Authors
  1. Sebastian Siller
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Corresponding author

Correspondence to Sebastian Siller.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local Institutional Review Board of the Ludwig-Maximilians-University Munich and agrees with all standards regarding the use of informed consent according to the guidelines of the local Institutional Review Board of the Ludwig-Maximilians-University Munich (Project # 17–168 and 18–259).

Informed consent

Informed consent was obtained from participants included in the study according to the guidelines of the local Institutional Review Board of the Ludwig-Maximilians-University Munich (Project # 17–168 and 18–259).

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The authors declare no competing interests.

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Siller, S., Skrap, B., Grabein, B. et al. Routine intraoperative microbiological smear testing in patients with reoperation after elective degenerative non-instrumented spine surgery–useful or negligible adjunct. Acta Neurochir 164, 891–901 (2022). https://doi.org/10.1007/s00701-022-05132-x

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  • DOI: https://doi.org/10.1007/s00701-022-05132-x

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