Management of infection after instrumented posterior spine fusion in pediatric scoliosis

Christine Ho, David L. Skaggs, Jennifer M. Weiss, Vernon T. Tolo

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

STUDY DESIGN. Case series retrospective review. OBJECTIVE. To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation. SUMMARY OF BACKGROUND DATA. The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS. The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed. RESULTS. Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05). CONCLUSION. To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.

Original languageEnglish (US)
Pages (from-to)2739-2744
Number of pages6
JournalSpine
Volume32
Issue number24
DOIs
StatePublished - Nov 2007

Fingerprint

Scoliosis
Spine
Pediatrics
Infection
Spinal Fusion
Coagulase
Debridement
Staphylococcus
Spinal Dysraphism
Cerebral Palsy
Medical Records

Keywords

  • Implant removal
  • Infection
  • Irrigation and debridement
  • Posterior spinal fusion
  • Scoliosis

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Management of infection after instrumented posterior spine fusion in pediatric scoliosis. / Ho, Christine; Skaggs, David L.; Weiss, Jennifer M.; Tolo, Vernon T.

In: Spine, Vol. 32, No. 24, 11.2007, p. 2739-2744.

Research output: Contribution to journalArticle

Ho, Christine ; Skaggs, David L. ; Weiss, Jennifer M. ; Tolo, Vernon T. / Management of infection after instrumented posterior spine fusion in pediatric scoliosis. In: Spine. 2007 ; Vol. 32, No. 24. pp. 2739-2744.
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abstract = "STUDY DESIGN. Case series retrospective review. OBJECTIVE. To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation. SUMMARY OF BACKGROUND DATA. The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS. The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed. RESULTS. Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40{\%}) idiopathic scoliosis, 10 patients (23{\%}) cerebral palsy, 3 patients (6{\%}) spina bifida, 1 patient (2{\%}) congenital scoliosis, and 17 patients (32{\%}) other. There were 31 patients (58{\%}) with surgery <6 months from initial fusion, and 22 (42{\%}) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47{\%}). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20{\%}). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47{\%}) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38{\%}) required a second I&D; of the patients with other diagnoses, 14 of 32 (44{\%}) required a second I&D, which was not a significant difference (P > 0.05). CONCLUSION. To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50{\%} chance that the infection will remain if all spinal implants are not removed. As nearly 50{\%} of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.",
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N2 - STUDY DESIGN. Case series retrospective review. OBJECTIVE. To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation. SUMMARY OF BACKGROUND DATA. The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS. The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed. RESULTS. Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05). CONCLUSION. To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.

AB - STUDY DESIGN. Case series retrospective review. OBJECTIVE. To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation. SUMMARY OF BACKGROUND DATA. The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS. The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed. RESULTS. Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05). CONCLUSION. To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.

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KW - Irrigation and debridement

KW - Posterior spinal fusion

KW - Scoliosis

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