WOUND INFECTION &

OSTEOMYELITIS
Laminectomy Wound Infection

Superficial Deep

 Superficial wound infection  Discitis

 Wound dehiscence  Osteomyelitis +/- epidural abscess
Risk Factors

 Age
 Long term steroid use
 Obesity
 DM
 Intraoperative hypothermia

 Most common organism: S. aureus

Superficial Wound Infections

 Skin
 Dermis
 Subcutaneous tissue
 Muscle
Superficial Wound Infection

 Send culture
 Empirical ABx: Vancomycin + Cefepime/Meropenem
 Change ABx according to sensitivity
 Wound debridement
 Secondary intention healing for shallow defects
 Wet to dry dressings, BD to TDS
 Half strength pyodine if purulent
 N/S once purulence subsides
 ABx: IV or oral, for 10-14 days
 Primary intention healing
 Ensure no tension on wound
 Closure over irrigation system, antibiotic beads or retention
sutures may be helpful
 Muscle flap if bone or dura is exposed
 Wound exploration and watertight dural closure if CSF leak
Post-op Discitis

 Causes:
 Lumbar discectomy
 LP, myelography, discography, lumbar sympathectomy, fusion etc
 ACDF
 Risk factors:
 Age
 Obesity
 Immunosuppression
 Systemic infection at the time of surgery
 Septic discitis:
 Direct inoculation during surgery
 Infection following aseptic necrosis of disc material
 Aseptic discitis:
 Aka avascular/chemical
 Autoimmune process
 ESR CRP less significant
 No PMN or lymphocytes on microscopy
 No organisms on culture
 Organism:
 S. aureus 60%
 Gram –ve: E.coli, Strep viridans, strep spp anaerobes
 TB, fungi
 Enteric flora if ALL breached + bowel perforation
 Onset of symptoms: 3 days to 8 months. Commonly 1st – 4th post-op week. Initial period of pain
relief and recovery from surgery
 Moderate to severe out of proportion surgical site pain exacerbated by spinal movement along
with muscle spasm.
 Pain radiates to hip, leg, scrotum, groin, perineum, abdomen.
 Fever and chills
 Point tenderness over affected level
 +/- purulent discharge
 ESR >20mm/hr.
(peaks POD 2-5, normalizes 3-6 weeks)
 CRP >6mg/dL
(peaks POD 2-3, normalized POD 5-14)
 WBC >10,000
Radiographic Evaluation

X- Ray: Changes appear in 3 months on plain and average time of spinal

fusion is 2 years.
Radiology of choice: MRI with contrast
Triad on MRI
Management

 Baseline labs + ESR, CRP, BCx

 Analgesics + muscle relaxant
 Abx
 IV for 1-6 weeks, then P/O for 1-6 months
 Vancomycin +/- Rifampin and Cefepime/Meropenem
 Activity restriction
 +/- steroid (helps reduce pain)
 C/S CT guided
Skull Osteomyelitis

 Contiguous spread (infected air sinus or scalp abscess)

 Penetrating trauma
 With long standing infecting, local erythema and swelling develops,
commonly over frontal and mastoids. Called Pott puffy tumor.
 Organisms:
 S. Aureus
 S. epidermidis
 E. coli (neonates)
 Imaging: bony resorption, periosteal reaction, contrast enhancement
 Management:
 Rongeur infected bone
 Infected craniotomy flaps removed and discarded
 Send c/s
 Scalp closure either with bone defect or titanium mesh cranioplasty
 6-12 weeks of antibiotics post-op (antibiotics without debridement are rarely
curative)
 Cranioplasty 6 months post-op if no signs of residual infection
THANK YOU!