The Difference in Surgical Site Infection Rates between Open and Minimally Invasive Spine Surgery for Degenerative Lumbar Pathology: A Retrospective Single Center Experience of 1,442 Cases

Presented at SMISS Annual Forum 2018
By K. Mueller
With Aakash Agarwal PhD, Boren Lin PhD, Christian Schultz MD, Vijay Goel PhD, Jeffrey Wang MD, Steve Garfin MD, Neel Anand MD, Hossien Elgafy MD, Dennis McGowan MD, Chris Karas MD,

Disclosures: K. Mueller None Aakash Agarwal PhD E; Spinal Balance Inc., Boren Lin PhD None, Christian Schultz MD None, Vijay Goel PhD None, Jeffrey Wang MD None, Steve Garfin MD None, Neel Anand MD None, Hossien Elgafy MD None, Dennis McGowan MD None, Chris Karas MD None,


Surgical site infection (SSI) in spinal surgery contributes to significant morbidity and healthcare resource utilization. Few studies have directly compared the rate of minimally invasive surgery (MIS) SSI with open surgery.


We sought to investigate whether MIS techniques had a smaller SSIR in degenerative lumbar procedures as compared with traditional open techniques.


A single-center, retrospective review of a prospectively collected database was queried from January 2013-2016 for adult patients who underwent lumbar decompression and/or instrumented fusion for which the surgical indication involved degenerative disease. The surgical site infection rate was determined for all procedures as well as in the open and minimally invasive groups. Risk factors associated with SSI were also reviewed for each patient.


A total of 1,442 lumbar spinal procedures were performed during this time period. Of these, there were 961 MIS and 481 open (67% vs. 33%, respectively). The overall surgical site infection rate was 1.5% (21/1,442). The SSIR for MIS was less than open techniques (0.5% vs 3.3%; p=0.0003). For decompression only, the infection rate for MIS and open was 0.4% vs 3.9% (p=0.04), and for decompression with fusion it was 0.7% vs 2.6%, respectively (p=0.68).


Our study demonstrates a significant sevenfold reduction in surgical site infections when comparing minimally invasive surgery with open surgery. This significance was also demonstrated with a tenfold reduction for procedures involving decompression alone. Procedures that require fusion as well as decompression showed a trend towards a decreased infection rate that did not reach clinical significance.