POSTOPERATIVE SPINAL INFECTIONS: THE CHALLENGE OF INCONSISTENT DEFINITIONS AND THE PATH TOWARDS CONSENSUS

Background The rising number of spinal surgeries has been paralleled by an increase in postoperative spine infections (PSIs), now identified as the third most common surgical complication. The absence of a standardized PSI definition complicates clinical management and research. This meta-epidemiological study was conducted to establish clear diagnostic criteria to aid clinicians and researchers in consistently identifying and reporting PSIs. Methods In accordance with PRISMA guidelines, a comprehensive literature search was performed using Ovid MEDLINE on March 14, 2024, by a medical librarian. Studies were considered eligible if they reported clear diagnostic definitions of PSI in at least ten adult patients. The primary objective was to review existing PSI diagnostic criteria and classify them into thematic clusters. We developed standardized diagnostic combinations based on 13 predefined criteria sourced from clinical practice guidelines and previous research (see Table 1). Results From an initial pool of 1,466 studies, 101 were included. The vast majority were retrospective (91/101, 92.1%), with most studies (77/101, 76.2%) utilizing established criteria, such as those from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) or the CDC. Seven studies combined these predefined criteria with additional detailed descriptions. Among studies using independent definitions, clinical signs and symptoms were the most commonly reported criteria (13/24, 54.2). The criteria were grouped into clinical, microbiological, and radiological categories, with most studies employing clinical criteria either alone or alongside microbiological or imaging findings (Figure 1). Conclusion These findings highlight the urgent need for a standardized definition of PSI that integrates clinical, microbiological, and radiological elements. Implementing such a unified diagnostic framework could enhance accuracy, address limitations related to hardware complications, wound drainage interpretation, and imaging ambiguities, and improve current surveillance practices. For any figures or tables, please contact the authors directly.