Improvement in pain after spinal surgery infection does not mean the risk of complications is eliminated

In a systematic review and meta-analysis of more than 2,600 patients, researchers found that infection at the site of spinal fusion surgery does not necessarily lead to greater long-term pain and disability, provided the implants are retained, but it does increase the risk of nonunion of the vertebrae, reoperation, and readmission.

In a systematic review and meta-analysis, the researchers showed that the infection of the spine fusion surgery site, if the implants are kept, does not necessarily lead to more pain and disability in the long term, but it increases the risk of non-union of the vertebrae, re-surgery and re-hospitalization.

According to Ambassador Arjan, citing Alam Khan, the results of a new study show that patients who develop an infection at the surgical site after spinal fusion surgery may achieve similar results in terms of pain and disability to patients without infection in the long term, despite controlling the infection and keeping metal instruments. However, the risk of some mechanical complications and the need for more medical interventions in these patients is still higher.

Spinal fusion or welding of vertebrae is one of the surgical methods to treat some erosive diseases, deformities and other problems of the spine. In this method, tools such as screws and metal rods are usually used to stabilize the beads and provide the conditions for their welding. Infection of the surgical site is one of the complications of this operation that can affect the treatment process and its long-term consequences.

Faced with this complication, doctors in many cases try to control the infection by cleaning the site of infection and prescribing antibiotics, and at the same time, by maintaining the stability and alignment of the spine by maintaining metal instruments. However, the long-term consequences of this approach and the possibility of subsequent complications are among the questions raised in this field.

The researchers of Tehran University of Medical Sciences, in collaboration with international researchers, evaluated the existing studies in the form of a systematic review and meta-analysis to investigate this issue. In this research, four scientific databases PubMed, Embase, Scopus and Web of Science were searched until the end of 2025. Finally, 11 studies including a total of 2,681 patients were included in the analysis. The average follow-up period of the patients was about 34 months, and in some studies, the follow-up continued for more than five years. To evaluate the results of the treatment, the researchers examined the amount of back and leg pain as well as the disability of the patients. The visual pain scale (VAS) was used to measure pain intensity, and the Esoteric Disability Index (ODI) was used to assess disability.

The results of this meta-analysis showed that there was no significant difference between the patients who had an infection after spinal fusion surgery and the patients who did not have an infection in terms of outcomes related to back pain, leg pain, and disability; Provided that the metal tools are preserved in the infected group. This finding suggests that the occurrence of infection after surgery does not necessarily mean experiencing more pain or poorer long-term function, and that patients whose infection is properly managed may achieve similar outcomes in terms of pain reduction and improved function as patients without infection. However, the examination of structural complications and the need for further medical interventions presented a different picture of the condition of these patients.

One of the important findings of the study was the increased probability of non-union of vertebrae or pseudoarthrosis in patients with infection. In this situation, the vertebrae that are supposed to be welded together after surgery are not completely connected; A problem that can be associated with pain, instability of the spine and the need for repeated surgery. Based on meta-analysis results, the chance of pseudarthrosis in infected patients whose surgical instruments were preserved was reported to be about 2.95 times that of patients without infection. Also, the chance of re-surgery, excluding the operations that are performed only to clear the infection, was about 3.3 times higher in the group with infection.

The probability of unplanned readmission was also increased in these patients. However, the researchers noted that there was a significant difference between the results of the studies in some mechanistic outcomes; Hence, the interpretation of the findings should be done with caution. On the other hand, no significant difference was observed between the two groups in the incidence of kyphosis at the joints of the vertebrae and adjacent parts of the spine (PJK). According to the researchers, the results of this study show that the evaluation of the success of infection treatment after spine surgery should not be limited only to the amount of pain reduction or improvement of the patient's function.

The patient's symptoms may improve after the infection is treated, but there is still a risk of complications such as non-union of the vertebrae, re-surgery and re-hospitalization. Hence, it is important to check the state of fusion of the vertebrae and the stability of the spine along with the evaluation of clinical symptoms. The researchers also emphasized the necessity of standardizing the definitions of infection, the timing of the evaluation of treatment outcomes, and the method of reporting mechanical complications in future studies in order to enable a more accurate comparison of research results.

This study was conducted with the participation of researchers including researchers from Tehran University of Medical Sciences and University of South Florida and was published in Journal of Spine Surgery in 2026. The findings of this research show that controlling infection and improving pain after spinal fusion surgery alone is not enough to ensure the long-term success of the treatment, and the evaluation of structural complications and the possible need for further interventions should also be considered in the follow-up of these patients.

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