Management of infection after instrumented posterior spine fusion in pediatric scoliosis.
METHODS
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.


BACKGROUND
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).


CONCLUSIONS
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.
Ho
Christine
C
Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
Skaggs
David L
DL
Weiss
Jennifer M
JM
Tolo
Vernon T
VT
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016025:Bone Transplantation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D006801:Humans; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000453:epidemiology / Q000601:surgery*; D055502:Secondary Prevention; D013123:Spinal Fusion / Q000295:instrumentation / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D007507:Therapeutic Irrigation
D000900:Anti-Bacterial Agents