title: Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes.
abstract: METHODS
  Retrospective case-control.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate a single surgeon's experience with infection after surgical treatment of adolescent idiopathic scoliosis, with a focus on the diagnosis, treatment, and impact on radiographic and patient-reported outcomes.
  
  
  BACKGROUND
  Although previous studies have evaluated this postoperative complication, no studies to date have looked at the impact of this complication on both radiographic and patient-reported outcomes.
  
  
  METHODS
  From 1986 to 2004, 236 patients were identified who underwent surgical treatment of adolescent idiopathic scoliosis and had at least 2-year follow-up. The medical records of patients who developed infection were retrospectively reviewed in detail. Preoperative and most recent postoperative radiographic parameters and Scoliosis Research Society 24 outcomes of both infected and noninfected patients were compared.
  
  
  RESULTS
  Of 236 patients 7 (3%) developed an infection. One was acute (17 days postoperative), and 6 were delayed (average 34.2 months postoperative). The most common presenting complaints included back pain (5 of 7) and localized swelling (4 of 7). All patients with delayed infection were treated with 1 surgery (irrigation and debridement, instrumentation removal) and 6 weeks of intravenous antibiotics. Of 6 patients 3 had pseudarthrosis. Culture results were: Staphylococcus epidermidis (n = 2), Propionibacterium acnes (n = 1), Enterococcus faecalis (n = 1), Group A Streptococcus (n = 1), no growth (n = 1). The patient with acute infection required 6 surgical procedures and 16 weeks of antibiotics. Cultures were positive for methicillin resistant Staphylococcus aureus and Serratia marscesens. Revision fusion surgery was performed 5 months after the infection was treated. Compared with the noninfected patients, those with infection had lower percent thoracic (P = 0.01) and lumbar (P = 0.06) curve correction. There was no difference in the pain, function, self-image, satisfaction, or total Scoliosis Research Society 24 scores.
  
  
  CONCLUSIONS
  Postoperative infection after the surgical treatment of idiopathic scoliosis can successfully be treated with irrigation and debridement, instrumentation removal, and a course of antibiotics. Although less curve correction was achieved in the infected group, there were no differences in patient-reported outcomes when compared with the noninfected group.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rihn
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: W Timothy
authors.initials: WT
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D013293:Enterococcus faecalis; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D011425:Propionibacterium acnes; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D016868:Serratia Infections / Q000175:diagnosis / Q000188:drug therapy; D012706:Serratia marcescens; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents