Double Drain Continuous Irrigation in Spinal Post Instrumentation Deep Wound Infection

Background: Deep wound infection is a serious complication in spinal surgeries especially if instrumentation was done or when associated with other risk factors. In many cases, debridement steps include removal of fixation system and reoperation after subsidence of infection. Objective: Evaluation of the use of a new technique after debridement in spinal post instrumentation deep wound infection to increase the chance of fixation system retention. Patients and Methods: During the period from June 2012 to August 2014, nine cases with different spinal fixation techniques were operated for debridement due to deep wound infection. The fixation system was not removed. After debridement, double wide bore drains were inserted from upper and lower parts of the wound. The upper drain was connected to continuous saline irrigation with added antibiotics and the lower drain was used for drainage. The upper drain was removed when the wash became clear. The lower drain was left in place for an additional one to two days to insure drainage. Patients were followed up for a period of 6 months. Results: Eight cases were clean within 5-7 days indicated by the clinical state and clearance of the drained fluid with no instrumentation removal thus avoiding another surgery. This technique failed to avoid removal of the fixation system in one case of post traumatic anterior cervical fixation. Conclusion: Continuous irrigation double drain system can be considered an efficient and safe technique that facilitates hardware retention, thus avoiding recurrence of symptoms and redo surgeries and decreases the expenses in the management of spinal post-instrumentation recent onset deep wound infections.