Management of postoperative infections after oblique lateral interbody fusion: A case series

Background

Oblique lateral interbody fusion (OLIF) is an effective surgical treatment for scoliosis, degenerative disc disease, and spondylolisthesis and is associated with a reported incidence of infection between 0.0 and 4.4%. Recent studies have reported perioperative complications associated with OLIF surgery including surgical site infections, but none described the management of these in detail. The present study describes the management of infections following OLIF surgery.

Methods

We performed a retrospective study of all adult patients (≥18 y-o) who had surgical site infection after undergoing OLIF surgery in combination with posterior long segment spinal fusion for degenerative scoliosis correction in a single spine unit from January 2013 to December 2020 with a minimal two-year follow-up.

Results

Among thirty patients who underwent OLIF surgery in combination with posterior long segment spinal fusion for degenerative scoliosis correction, four patients (2 males, 2 females, mean age: 64.5 years) suffered from surgical site infection. All patients had radiological signs of deep surgical site infection and had positive bacterial culture results. Patients were treated with revision surgery combined with antimicrobial therapy. At follow up all four showed major improvement in pain, ambulatory status, and infection status.

Conclusion

We showed that aggressive surgical debridement, drainage, and irrigation combined with 6-8 weeks of intravenous antibiotics; followed by long-term oral antibiotics in most severe cases; are effective for the management of surgical site infections associated with OLIF surgery. Retention of stable hardware and replacement of unstable fixation in cases of spinal instability and progressive deformity is an adequate strategy.