Surgical revision strategies for postoperative spinal implant infections (PSII)

Over the last years the number of spine surgeries with instrumentation has grown to an indispensable column in the treatment for different pathologies of the spine. A further increase in the incidence of instrumented spinal surgery is expected throughout the next years. Although the implementation and development of new techniques offer faster and more minimal invasive procedures, shortening surgery time, reducing soft tissue injury and revision due to hardware misplacement, the incidence of postoperative spinal implant infections (PSII) remains high. PSII related complications and revision procedures pose an enormous socioeconomic burden. Therefore, standardized strategies and protocols for treatment of PSII are urgently needed. While in former times hardware exchange or hardware removal was common practise in the field of spine surgery this approach has changed over the last years. Although the evidence from clinical studies in the field of PSII is of limited evidence, critical variables for revision strategies of PSII have been identified. Further, to quickly advance in the field of PSII it is certainly important to extrapolate and learn using data regarding the management from other fields of prosthetic joint infections. This should include clinical as well as experimental work in particular in the context of the biofilm, sonication as well as microbiological concepts. Over the last years, at our institution standardized procedures for diagnostic, surgical as well as antimicrobial treatment have been developed, based on the latest recommendations in peer-reviewed literature and our own data. Here we give an overview about surgical revision strategies for PSII and discuss the key points of our standardized protocol.