title: Outcomes of infection following pediatric spinal fusion.
abstract: BACKGROUND
  Removal of instrumentation is often recommended as part of treatment for spinal infections, but studies have reported eradication of infection even with instrumentation retention by using serial débridements and adjuvant antibiotic pharmacotherapy. We sought to determine the effect of instrumentation retention or removal on outcomes in children with spinal infections.
  
  
  METHODS
  We retrospectively reviewed the cases of patients who experienced early (< 3 mo) or late (≥ 3 mo) infected spinal fusions. Patients were evaluated at least 2 years after eradication of the infection using the following protocol outcomes: follow-up Cobb angle, curve progression and nonunion rates.
  
  
  RESULTS
  Our sample included 35 patients. The mean age at surgery was 15.1 ± 6.0 years, 65.7% were girls, and mean follow-up was 41.7 ± 26.9 months. The mean Cobb angle was 63.6° ± 14.5° preoperatively, 29.4° ± 16.5° immediately after surgery and 37.2° ± 19.6° at follow-up. Patients in the implant removal group (n= 21) were more likely than those in the implant retention group (n= 14) to have a lower ASA score (71.4% v. 28.6%,p= 0.03), fewer comorbidities (66.7% v. 21.4%,p= 0.03), late infections (81.0% v. 14.3%,p= 0.01) and deep infections (95.2% v. 64.3%,p= 0.03). Implants were retained in 12 of 16 (75.0%) patients with early infections and 2 of 19 (10.5%) with late infections. Patients with implant removal had a higher pseudarthrosis rate (38.1% v. 0%,p= 0.02) and a faster curve progression rate (5.8 ± 9.8° per year v. 0.2 ± 4.7° per year,p= 0.04).
  
  
  CONCLUSIONS
  Implant retention should be considered, irrespective of the timing or depth of the infection.
authors.affiliation: The University of Toronto Faculty of Orthopaedic Surgery and the Hospital for Sick Children, Toronto, Ont.
authors.forename: Amir
authors.initials: A
authors.lastname: Khoshbin
authors.affiliation: The Hospital for Sick Children, Toronto, Ont.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lysenko
authors.affiliation: The Hospital for Sick Children, Toronto, Ont.
authors.forename: Peggy
authors.initials: P
authors.lastname: Law
authors.affiliation: The University of Toronto Faculty of Orthopaedic Surgery and the Hospital for Sick Children, Toronto, Ont.
authors.forename: James G
authors.initials: JG
authors.lastname: Wright