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Background <p>Postoperative spinal implant infection (PSII) is a clinically significant complication following spinal instrumentation, with diagnostic challenges related to biofilm formation and the lack of standardized criteria. This study aimed to investigate clinical, laboratory, and perioperative factors associated with PSII using a standardized spine-specific diagnostic framework proposed by the Musculoskeletal Infection Society (MSIS) European Bone and Joint Infection Society (EBJIS) workgroup.</p> Methods <p>In this retrospective cohort study, 224 adult patients who underwent posterior spinal instrumentation surgery between January 2025 and January 2026 were included. Demographic characteristics, comorbidities, laboratory parameters, perioperative variables, and microbiological findings were obtained from electronic medical records. PSII was defined using a standardized spine-specific diagnostic framework proposed by the MSIS–EBJIS workgroup, integrating clinical, microbiological, and histopathological criteria. Variables with <i>p</i> &lt; 0.10 in univariate analysis and strong clinical plausibility were considered for multivariate logistic regression.</p> Results <p>PSII developed in 18 patients (8.0%). No significant association was found between PSII and demographic variables or comorbidities. Elevated C-reactive protein (CRP) levels and lower serum albumin levels were associated with PSII (<i>p</i> &lt; 0.05). In univariate analysis, American Society of Anesthesiologists (ASA) score ≥ 3, emergency surgery, perioperative steroid use, low molecular weight heparin use, postoperative prone recovery positioning, and intensive care unit admission were significantly associated with PSII. In multivariate analysis, only emergency surgery remained independently associated with PSII (OR: 6.48; 95% CI: 1.28–32.70; <i>p</i> = 0.024).</p> Conclusions <p>PSII remains a clinically important complication following spinal instrumentation surgery. In this study, emergency surgery was the only variable independently associated with PSII; however, this finding should be interpreted cautiously given the limited number of events and wide confidence intervals. Elevated CRP levels and hypoalbuminemia were identified as associated findings rather than independent predictors. The use of structured spine-specific diagnostic frameworks based on the MSIS–EBJIS workgroup definition may improve consistency in PSII classification and enhance comparability across future studies. Larger prospective studies are needed to further clarify independent predictors and optimize preventive strategies. Emergency spinal instrumentation procedures may represent higher-risk clinical settings for PSII and may warrant enhanced perioperative infection prevention strategies and closer postoperative surveillance.</p>

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Postoperative spinal ımplant ınfection defined using a standardized MSIS–EBJIS spine-specific diagnostic framework: risk factors in posterior spinal ınstrumentation surger

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Ali Kutta Çelik,
  • Mustafa Uğuz,
  • Fatih Erdem,
  • Berfin Çirkin Doruk,
  • Mutlu Alımlı

摘要

Background

Postoperative spinal implant infection (PSII) is a clinically significant complication following spinal instrumentation, with diagnostic challenges related to biofilm formation and the lack of standardized criteria. This study aimed to investigate clinical, laboratory, and perioperative factors associated with PSII using a standardized spine-specific diagnostic framework proposed by the Musculoskeletal Infection Society (MSIS) European Bone and Joint Infection Society (EBJIS) workgroup.

Methods

In this retrospective cohort study, 224 adult patients who underwent posterior spinal instrumentation surgery between January 2025 and January 2026 were included. Demographic characteristics, comorbidities, laboratory parameters, perioperative variables, and microbiological findings were obtained from electronic medical records. PSII was defined using a standardized spine-specific diagnostic framework proposed by the MSIS–EBJIS workgroup, integrating clinical, microbiological, and histopathological criteria. Variables with p < 0.10 in univariate analysis and strong clinical plausibility were considered for multivariate logistic regression.

Results

PSII developed in 18 patients (8.0%). No significant association was found between PSII and demographic variables or comorbidities. Elevated C-reactive protein (CRP) levels and lower serum albumin levels were associated with PSII (p < 0.05). In univariate analysis, American Society of Anesthesiologists (ASA) score ≥ 3, emergency surgery, perioperative steroid use, low molecular weight heparin use, postoperative prone recovery positioning, and intensive care unit admission were significantly associated with PSII. In multivariate analysis, only emergency surgery remained independently associated with PSII (OR: 6.48; 95% CI: 1.28–32.70; p = 0.024).

Conclusions

PSII remains a clinically important complication following spinal instrumentation surgery. In this study, emergency surgery was the only variable independently associated with PSII; however, this finding should be interpreted cautiously given the limited number of events and wide confidence intervals. Elevated CRP levels and hypoalbuminemia were identified as associated findings rather than independent predictors. The use of structured spine-specific diagnostic frameworks based on the MSIS–EBJIS workgroup definition may improve consistency in PSII classification and enhance comparability across future studies. Larger prospective studies are needed to further clarify independent predictors and optimize preventive strategies. Emergency spinal instrumentation procedures may represent higher-risk clinical settings for PSII and may warrant enhanced perioperative infection prevention strategies and closer postoperative surveillance.