Frequency of surgical site infection in patients undergoing lumbar microdiscectomy
DOI:
https://doi.org/10.61529/idjp.v35i2.528Abstract
Background: Lumbar microdiscectomy is a common minimally invasive procedure for disc herniation, but SSI is a major complication, especially in LMICs where incidence may be higher due to systemic factors.
Material and Methods: This prospective study of 100 adult patients who underwent lumbar microdiscectomy for lumbar disc herniation at Lady Reading Hospital, Peshawar, Pakistan, from 10 July 2025 to 10 January 2026. Inclusion criteria were patients aged 18–75 years with symptoms >6 weeks; exclusions included prior surgery at the same site, instrumentation, pre-existing infection, severe immunodeficiency, or pregnancy. SSI was defined according to CDC criteria within 30 days postoperatively, with initial clinical assessment performed at 10 days based on wound redness, VAS >4 or cloudy drainage. Data on demographics, comorbidities, and socioeconomic factors were collected. Analysis was performed using frequencies, means/medians, and chi-square or Fisher’s exact test.
Results: 13 (13%) of 100 patients had SSI. The mean age was 46.2 ± 12.8 years; 62% were male. The mean BMI was 28.4 ± 5.1 kg/m2; 38% were obese (BMI > 30). SSI was significantly associated with comorbidities, including Obesity (23.7% vs. 6.5%, p=0.012), diabetes (31.8% vs. 7.7%, p=0.003), smoking (22.9% vs. 7.7%, p=0.028), and rural residence (18.9% vs. 4.8%, p=0.032).
Conclusions: The 13% SSI rate in this LMIC group exceeds high-resource series (1-3%) but aligns with regional posterior spine surgery data. Risk factors are Obesity, diabetes, smoking, and rural residence. Enhance perioperative and infection-control practices to reduce SSI in resource-limited settings.
Keywords: Disc herniation, Lumbar microdiscectomy, Spine surgery, Surgical site infection.
References
Evans L, O'Donohoe T, Morokoff A, Drummond K. The role of spinal surgery in the treatment of low back pain. Med J Aust. 2023; 218(1): 40-45. DOI: https://doi.org/10.5694/mja2.51788
Sobański D, Staszkiewicz R, Stachura M, Gadzieliński M, Grabarek BO. Presentation, diagnosis, and management of lower back pain associated with spinal stenosis: A narrative review. Med Sci Monit. 2023; 29: e939237.
DOI: https://doi.org/10.12659/msm.939237
Choi JY, Park SM, Kim HJ, Yeom JS. Recent updates on minimally invasive spine surgery: Techniques, technologies, and indications. Asian Spine J. 2022; 16(6): 1013-21. DOI: https://doi.org/10.31616/asj.2022.0436 .
Diwan AD, Melrose J. Intervertebral disc degeneration and how it leads to low back pain. JOR Spine. 2023; 6(1): e1231. DOI: https://doi.org/10.1002/jsp2.1231
Jung B, Han J, Song J, Ngan A, Essig D, Verma R. Interventional therapy and surgical management of lumbar disc herniation in spine surgery: A narrative review. Orthop Rev (Pavia). 2023; 15: 88931. DOI: https://doi.org/10.52965/001c.88931
Radcliff K, Siburn S, Murphy H, Wong A, Anderson DG. Surgical site infection following isolated lumbar discectomy: risk factors and outcomes. Spine J. 2024; 24(5): 845-52. DOI: https://doi.org/10.1016/j.spinee.2024.03.017
Zuo Q, Zhao K, Dong B, Zhou Y, Wang X, Maimaiti A, et al. Analysis of risk factors for surgical site infection in spinal surgery patients and study of direct economic losses. BMC Musculoskelet Disord. 2024; 25(1): 109. DOI: https://doi.org/10.1186/s12891-024-08149-8
Tsantes AG, Papadopoulos DV, Vrioni G, Sioutis S, Sapkas G, Benzakour A, et al. Spinal infections: An update. Microorganisms. 2020; 8(4): 476. DOI: https://doi.org/10.3390/microorganisms8040476
Bucataru A, Balasoiu M, Ghenea AE, Zlatian OM, Vulcanescu DD, Horhat FG, et al. Factors contributing to surgical site infections: A comprehensive systematic review. Clin Pract. 2023; 14(1): 52-68.
DOI: https://doi.org/10.3390/clinpract14010006
Alqahtani S, Alnaqa M, Alqahtani A, Alqahtani M, Alqahtani A, Alqahtani W, et al. Risk factors and outcomes of surgical site infections of the spine. J Clin Med. 2025; 14(10): 3520. DOI: https://doi.org/10.3390/jcm14103520
Li J, Song M, Huang X, Zhu H, Zhang Y. Risk factors for deep surgical site infection following open posterior lumbar fusion. Medicine (Baltimore). 2024; 103(51): e41014. DOI: https://doi.org/10.1097/md.0000000000041014
Shen X, Gao Y, Zhang P, Zhu L, Jiang Z, Shi H, et al. Subcutaneous lumbar spine index as a risk factor for surgical site infection after lumbar fusion surgery. Spine (Phila Pa 1976). 2024; 49(12): E189-E195. DOI: https://doi.org/10.1177/21925682221146503
Surgical Site Infection (SSI) Prevention Guideline [Internet]. Infection Control. 2024. Available from: https://www.cdc.gov/infection-control/hcp/surgical-site-infection/index.html
Zhang T, Lian X, Chen Y, Cai B, Xu J. Clinical outcome of postoperative surgical site infections in patients with posterior thoracolumbar and lumbar instrumentation. J Hosp Infect. 2022; 128: 26-35. DOI: https://doi.org/10.1016/j.jhin.2022.06.014
Schömig F, Perka C, Pumberger M, Ascherl R. Implant contamination as a cause of surgical site infection in spinal surgery. BMC Musculoskelet Disord. 2020; 21(1): 634. DOI: https://doi.org/10.1186/s12891-020-03644-0 .
Sun Y, Ramapuram H, Tracz J, Howell S, Laskay NMB, James M, et al. Intraoperative vancomycin for preventing infection after open spine surgery: A systematic review and meta-analysis of randomized controlled trials. J Neurosurg Spine. 2025; 43(4): 509-518. DOI: https://doi.org/10.3171/2025.3.spine2547
Khan NR, Thompson CJ, DeCuypere M, Angotti JM, Kalobwe E, Muhlbauer MS, et al. A meta-analysis of spinal surgical site infection and vancomycin powder. J Neurosurg Spine. 2014; 21(6): 974-83. DOI: https://doi.org/10.3171/2014.8.spine1445
Suszczyńska J, Grabala M, Grabala P. Modulation of surgical site infection risk in spinal and thoracic surgeries through operative parameters: A narrative review. J Clin Med. 2025; 14(22): 8124. DOI: https://doi.org/10.3390/jcm14228124
Kreinces JB, Roof MA, Friedlander S, Huang S, Bosco JA 3rd, Fischer C. The temporality of deep surgical site infection rates following spinal laminectomy and fusion. Int J Spine Surg. 2022; 16(6): 1068-74. DOI: https://doi.org/10.14444/8358
White AJ, Fiani B, Jarrah R, Momin AA, Rasouli J. Surgical site infection prophylaxis and wound management in spine surgery. Asian Spine J. 2022; 16(3): 451-61. DOI: https://doi.org/10.31616/asj.2020.0674
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Copyright (c) 2026 Muhammad Nawaz Khan, Adnan khan, Farooq Azam, Muhammad Sohaib Khan, Syed Shayan Shah, Muhammad Aamir
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