Incisional Swelling And Drainage After Spine Surgery


Consult Page

61F h/o prior lumbar spine surgery here with drainage from incision

Initial Imaging

Fig. 73.1, Tender, erythematous, and swollen lumbar incision with a small area of active purulent discharge (arrow) at the superior aspect of the incision (A); there is significant drainage on the patient’s home dressing (B).

Walking Thoughts

  • What was the patient’s prior surgery? When was the surgery?

  • Is there hardware present?

  • How was the patient’s postoperative course?

  • What does the patient’s incision look like (e.g. erythema, swelling) and is there any drainage?

  • If there is drainage, what does it look like?

  • Does the patient have fevers, chills, meningitis, or other systemic signs of infection?

  • What is the patient’s current neurological exam?

  • What other symptoms is the patient having?

  • Are there symptoms of possible cerebrospinal fluid leak such as positional headaches, nausea, or vomiting?

  • Does the patient have any risk factors for poor wound healing or infection (e.g. diabetes, obesity, smoking, cancer history, prior radiation, poor nutritional status)? Is the patient immunocompromised?

  • Were there any intraoperative risk factors for infection (e.g. prolonged case, use of implants, revision surgery, prior infection)?

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