Deep surgical site infection after anterior decompression and fusion with plate fixation for cervical spondylotic radiculopathy or myelopathy

Objectives: To analyze the diagnosis and management of deep surgical site infection (SSI) with implant involved after anterior decompression and fusion for cervical spondylotic radiculopathy/myelopathy (CSR/CSM). Patients and methods: Data of the patients who underwent anterior cervical decompression and fusion with plate fixation due to CSR/CSM were retrospectively reviewed. Cases with postoperative deep SSI with implant involved were identified and analyzed. Results: A total of 1287 patients were finally included. Five patients (0.4%) were found to be with deep SSI. Bone fusion was not obtained when SSI was confirmed in each patient. Three cases were cured using one or two debridement and postoperative antibiotic therapy. Two cases with delayed diagnosis needed anterior implants removal, interbody fusion with autologous iliac bone and posterior lateral mass screw fixation at the first/second debridement. One of the two patients developed esophagus perforation after a second debridement and experienced one-month open drainage. All of the patients were cured without relapse of infection. Conclusion: For early deep SSI after anterior cervical decompression and fusion, surgical debridement was effective to eradicate infection. But for cases with delayed diagnosis, anterior debridement with prophylactic implant removal and posterior reconstruction was an ideal option. Esophagus perforation complicated with multiple debridements should be paid attention to and avoided. (C) 2015 Published by Elsevier B.V.