Infection rate after spine surgery in cerebral palsy is high and impairs results: multicenter analysis of risk factors and treatment.
Infection is a serious complication of surgery to correct scoliosis in patients with cerebral palsy (CP). We obtained multicenter representative figures for deep and superficial infection rates, analyzed risk factors and treatment outcomes, and compared deformity correction relative to infection. We retrospectively reviewed 157 patients who had posterior spinal fusion for CP at one of eight centers. Preoperative and intraoperative variables were subjected to multivariate analysis to determine factors predictive of infection. There were 16 wound infections (10%; nine deep, seven superficial). Only two study factors predicted infection: higher preoperative white blood cell count (8.5 versus 6.4 [in those without infection] x 10(3)) and use of a unit rod (15% versus 5% for bent rods). Fourteen patients underwent irrigation and débridement procedures. Five infections required 2 months or longer to resolve. Two had implant removal. Final curve correction was lower for those with deep infections than those without (67% versus 53%, respectively). We noted a trend toward greater percentages of pain at last followup in those with deep infection than in those without infection (50% versus 18%, respectively) but the study was not adequately powered to confirm this point. Our infection rate in scoliosis surgery for CP was higher than that for most elective spinal deformity surgery.


METHODS
Level III, retrospective case-control study. See Guidelines for Authors for a complete description of levels of evidence.
Sponseller
Paul D
PD
The Johns Hopkins Medical Institutions, 601 North Caroline St #5212, Baltimore, MD 21287-0882, USA. psponse@jhmi.edu
Shah
Suken A
SA
Abel
Mark F
MF
Newton
Peter O
PO
Letko
Lynn
L
Marks
Michelle
M
D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D006801:Humans; D016268:Internal Fixators; D016015:Logistic Models; D018655:Lymphocyte Count; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult