IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 2 Ver. 4 February. (2018), PP 20-24 www.iosrjournals.org DOI: 10.9790/0853-1702042024 www.iosrjournals.org 20 | Page Postoperative Spinal Wound Infection in Neurosurgical wards at RIMS, a Single Centre Experience Dr Alok Chandra Prakash (1) ,Dr Anand Prakash (2) ,Dr Chandra Bhushan Sahay (3). 1 -Senior Resident 2- Associate Professor 3- Professor Department of Neurosurgery RIMS Ranchi,Jharkhand,India. Corresponding author: Dr Alok Chandra Prakash Abstract: With modern surgical techniques and perioperative antibiotics, spinal infection after surgery is relatively uncommon. Certain patient and surgical treatments are however at higher risk and should be treated with extra caution. Surgical site infection (SSI) following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2–4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 and 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post- operative levels should be done when suspecting SSIs following spine surgery. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. Keywords: Surgical Site Infection,Spinal Wound Infection,post-procedural discitis, imaging, risk factors, Staphylococcus aureus, inflammatory markers. -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 26-01-2018 Date of acceptance: 13-02-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Surgical site infections (SSIs) following spine surgery comprise superficial and deep infections and were first described as a clinical entity by Turnbull in 1953(1). Superficial spine infections are localized to the skin and subcutaneous tissue. On the other hand, deep infections disseminate under the fascia and encompass discitis, epidural abscess, and spondylitis; this type of infections is characterized by inflammation of the intervertebral disks and associated soft and articular tissues(2). Although SSIs following spine surgery can be prevented to a great extent using general measures intended to avert all potential SSIs, they remain a dreaded complication. Some of these general preventive approaches include adoption of aseptic techniques, optimization of patient status pre-operatively as well as intra- operatively, appropriate use of pre-operative antibiotics, and good post-operative follow-up(3-6). SSIs result in significant increase in morbidity and incur a substantial cost to the health care system(7). In one study, each episode of wound infection following spine procedure contributed to a mean increase in the cost of care compared to a non-complicated case(8). A high index of suspicion is compulsory in every patient presenting with back pain after any invasive diagnostic or therapeutic spinal procedure(9). Physicians may sometimes struggle with diagnosing SSI due to a number of difficulties, including the paucity of physical examination findings, mimicry of non-infective conditions, presence of minor symptoms leading to patients not seeking medical attention, inadequate follow-up strategies in some institutions, and the previous dependence on plain X- rays that lack sensitivity for diagnosing SSI(10). However, the use of a well-defined systematic approach would help in establishing a definitive diagnosis in a timely manner. This would be based on a comprehensive history, thorough physical examination, detailed laboratory studies, blood cultures, and cultures of wound or computed tomography (CT)-guided aspirate material, and imaging studies.