What is the incidence of post-operative infection following laminoplasty?

Incidence of Post-Operative Infection Following Laminoplasty

The incidence of post-operative infection following laminoplasty is approximately 7.2% in the acute post-operative period, based on the most recent high-quality evidence 1.

Infection Rates in Laminoplasty

Laminoplasty is a surgical procedure commonly performed for multilevel degenerative cervical stenosis causing myelopathy. The procedure allows for motion preservation while addressing spinal cord compression. Understanding the risk of post-operative infection is critical for:

• Proper patient counseling
• Implementation of preventive measures
• Optimizing post-operative outcomes

Evidence on Infection Rates

A comprehensive retrospective study of 222 patients who underwent laminoplasty with a minimum 2-year follow-up (average 4.97 years) revealed:

• 15 patients (7.2%) required reoperation for infection requiring at least one irrigation and debridement in the acute post-operative period 1
• Overall reoperation rate was 13.5%, with infection being a significant contributor 1

An earlier study examining complications in 204 patients undergoing unilateral open-door laminoplasty reported:

• Deep infection was among the complications observed, contributing to an overall complication rate of 10.8% 2

Risk Factors for Post-Operative Infection

Several factors may increase the risk of post-operative infection following laminoplasty:

1. Concomitant procedures: Patients who had a concomitant laminectomy demonstrated a significantly higher reoperation rate (p = .03) 1

2. Patient-related factors: Based on general orthopedic surgery evidence, the following may increase infection risk:

   • Advanced age
   • Male sex
   • Higher ASA grade
   • Comorbid diseases
   • Preoperative anemia 3

3. Surgical factors:

   • Longer operative time
   • Greater surgical complexity
   • Presence of cancer 3

Prevention Strategies

Antibiotic Prophylaxis

Perioperative antibiotic prophylaxis is essential for preventing surgical site infections:

• Administer broad-spectrum intravenous antibiotics within 60 minutes before skin incision 4
• Some agents such as fluoroquinolones and vancomycin require administration over 1-2 hours, and should begin within 120 minutes before incision 4
• Vancomycin may be associated with a lower risk of infection compared to cephalosporins in orthopedic procedures 5

Intraoperative Measures

Several intraoperative measures can reduce the risk of infection:

• Use of alcohol-based skin antisepsis solutions (or chlorhexidine for patients with alcohol allergies) 4
• Use of fascial wound protectors 4
• Changing gloves and instruments before wound closure (shown to reduce surgical site infection by 13%) 4
• Maintaining normothermia during the procedure 4
• Controlling blood glucose levels 4

Impact of Post-Operative Infection

Infection following laminoplasty can have significant consequences:

• Increased risk of mortality (odds ratio 4.68) 3
• Extended hospital stay (average increase of 6.45 days) 3
• Need for reoperation and debridement 1
• Potential compromise of surgical outcomes

Clinical Implications

When counseling patients about laminoplasty:

• Discuss the approximately 7.2% risk of infection requiring reoperation
• Identify and optimize modifiable risk factors before surgery
• Implement comprehensive infection prevention protocols
• Maintain vigilance for early signs of infection to allow prompt intervention

Despite the risk of infection, laminoplasty continues to compare favorably with alternative procedures such as laminectomy and fusion for the management of multilevel cervical stenosis causing myelopathy 1.