Wild spine infections: Long-term outcomes and surgical strategies in refractory postoperative spinal infections

Background: Most postoperative spinal infections resolve with timely debridement and culture-directed antimicrobial therapy. A minority, however, progress to persistent infection with osseous destruction, mechanical instability, and repeated surgical failure. Evidence-based strategies for managing this high-risk salvage population remain limited. This study aimed to evaluate the long-term clinical, neurological, and radiological outcomes of patients undergoing definitive reconstructive surgery after multiple failed revision procedures for refractory postoperative spinal infection. Methods: We retrospectively reviewed patients who underwent two or more revision surgeries for refractory postoperative spinal infection with associated instability or deformity. Clinical outcomes were assessed with the visual analog scale (VAS), Oswestry disability index (ODI), and Frankel neurological grade; radiological outcomes focused on sagittal alignment. All patients underwent aggressive debridement followed by posterior, anterior, or combined reconstruction, with adjunctive antimicrobial therapy and hyperbaric oxygen. Given the limited sample size, statistical analyses were considered hypothesis-generating. Results: Thirteen patients (mean age, 47.7 years) with a mean follow-up of 64 months and a mean of 4.9 prior spinal surgeries were included. Mean VAS score decreased from 9.5 preoperatively to 1.7 at 1 year ( p < 0.001), and mean ODI improved from 62.4 to 19.2 ( p < 0.001). Neurological improvement occurred in 53.8% of patients, with complete recovery in 30.8%. Sagittal segmental alignment improved significantly after surgery, but the magnitude of radiological correction did not correlate with pain or functional outcomes. Conclusion: In refractory postoperative spinal infection requiring salvage reconstruction, restoration of mechanical stability, rather than radiological correction, is the principal determinant of clinical and neurological recovery. Early recognition and timely definitive reconstruction may improve long-term outcomes.