Over the past several decades, the total number of spinal fusion procedures has continuously risen worldwide. With a reported incidence of 0.7–20%, postoperative spinal implant infections (PSIIs) are one of the most common and devastating complications in spine surgery, causing increased patient mortality and morbidity, poor long-term outcomes and high health-care costs. While in arthroplasty, clear definitions, diagnostic guidelines, and therapeutic algorithms have been established for periprosthetic joint infections (PJIs), literature on PSII remains limited. Due to similarities in pathogenesis, symptoms, diagnosis, and treatment, recommendations for PSII can be derived from existing literature on PJI. In most cases of PSII, surgical revision is indicated, which, however, always needs to be accompanied by an adequate long term antibiotic treatment to achieve efficient pathogen eradication and clinical results. Still, a standardized algorithm-based treatment system is lacking but necessary to ensure optimal treatment of PSII.
The purpose of this series is to provide an overview of evidence-based strategies for the diagnosis and treatment of PSIIs covering their epidemiology, diagnosis of acute and delayed infections, implications from existing literature on PJIs, surgical strategies, antibiotic treatment, and patient-reported outcomes. To ensure a comprehensive and interdisciplinary perspective we have invited spine experts from neurosurgery and orthopedic surgery backgrounds as well as infectiology experts. We are very excited to share this series and hope you find it informative and valuable in the care of your patients.
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Spine Surgery for the series “Postoperative Spinal Implant Infection (PSII)”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jss-2020-psii-10). The series was commissioned by the editorial office without any funding or sponsorship. MP served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Journal of Spine Surgery from Nov. 2018 to Nov. 2020. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.