Antibiotic-loaded allograft decreases the rate of acute deep wound infection after spinal fusion in cerebral palsy.
METHODS
A retrospective matched cohort study with control group.


OBJECTIVE
To compare the infection rate after posterior spinal fusion with unit rod instrumentation with or without gentamicin-impregnated allograft bone in children with cerebral palsy (CP).


BACKGROUND
Previous studies evaluating wound infection rates after spinal fusion surgery in children with CP report an 8.7% to 10% wound infection rate. The concept of using antibiotic-loaded bone graft (AbBGF) to provide local antibiotics has been explored in high risk patients, such as those with osteomyelitis or infected joint arthroplasty. There have been no reports of using AbBGF prophylactically in spine surgery.


METHODS
After IRB approval, the medical records of 220 children with CP who underwent spinal fusion with unit rod instrumentation for a primary spinal deformity between January 2000 through December 2006 at a single institution were retrospectively reviewed. We evaluated the incidence of postoperative wound infection in patients with AbBGF and those without bone graft (BGF).


RESULTS
One hundred fifty-four patients received AbBGF during spinal fusion surgery and 6 patients (3.9%) developed a deep wound infection. Ten (15.2%) of the 66 patients without AbBGF developed a deep wound infection. The difference between groups was statistically different (P = 0.003). The mean age at surgery, preoperative Cobb angle, correction rate, operative time, and estimated blood loss were not statistically different between the 2 groups (P > 0.05). The length of hospital stay was decreased in the AbBGF group (P < 0.05).


CONCLUSIONS
The incidence of deep wound infection after spinal fusion in 220 children with CP scoliosis decreased from 15% to 4% with the use of prophylactic antibiotics in the corticocancellous allograft bone.
Borkhuu
Battugs
B
Department of Orthopedics, Alfred I duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19803, USA.
Borowski
Andrzej
A
Shah
Suken A
SA
Littleton
Aaron G
AG
Dabney
Kirk W
KW
Miller
Freeman
F
D000208:Acute Disease; D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000295:instrumentation* / Q000379:methods; D016025:Bone Transplantation / Q000009:adverse effects / Q000295:instrumentation; D002547:Cerebral Palsy / Q000382:microbiology* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices / Q000009:adverse effects / Q000382:microbiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D014184:Transplantation, Homologous
D005839:Gentamicins