External contamination more often causes early, deep wound infections in lumbosacral fusions than surgical contamination or haematogenous infection
Bibliographic record
Abstract
Introduction: Surgical site infections (SSI) after posterior stabilization of the spine (PS) are usually treated by implant removal and optional reinstrumentation if loosening of one or more screws is perceived.There is presently no conclusive data that shows the success rate of the treatment of SSI after PS without implant removal when no radiological signs of screw loosening (RSL) are perceived.If the success rate was very low, hospital stay and number of operations could be significantly lower if an early implant removal would be performed.However, if implant removal would not be necessary, the spine would remain stabilized and the patients would be spared a more invasive procedure.The primary objective of this investigation was to analyze if treatment of SSI after PS without RSL shows a sufficient success rate without implant removal.Methods: All patients who were treated for a SSI after PS without RSL in a single spine center from 12/2009 to 03/2020 were enrolled in a retrospective analysis.Type of treatment, demographic and clinical data were recorded.All patients were initially treated by revision surgery with debridement and irrigation and subsequent antibiotic therapy.Implant removal was performed if the initial treatment did not lead to normalization of soft tissue and laboratory tests (with regard to infection).Statistical analysis was performed by SPSS 25.Descriptive data are given as mean and standard error of mean, a chi square test was performed.Results: Of the 32 enrolled patients, 17 had an early SSI (<6 weeks after surgery), 15 a late SSI ( 6 weeks).In 81.3% (26/32) the SSI was treated without implant removal: 12/17 in early SSI, 11/15 in late SSI.The difference was not significant (p>0.05).One patient died, all other patients were discharged from the hospital with no more laboratory signs of the infection and with closed soft tissues.Hospital stay was 35.3 days (4,9).Patients were operated 2.9 times (0.7) during the hospital stay.Conclusion: In our group of patients the success rate of irrigation and debridement without implant removal showed a success rate of 81.3%.In the light of this data, performing at least 2 irrigations and debridements prior to implant removal seems to be a valid treatment option in SSI after PS if there are RSL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".