title: Deep Spine Infection After Acupuncture in the Setting of Spinal Instrumentation.
abstract: Acupuncture can be used to manage chronic pain. The most common complications related to acupuncture include pain, bruising, bleeding, or symptom exacerbation. Rarely, more serious adverse events occur, including infection, pneumothorax, septic arthritis, and peripheral nerve injury. To our knowledge, there are no reports of complications associated with acupuncture following spinal instrumentation.
  
  
  
  To report a case of deep infection as a rare complication of acupuncture following posterior spinal fusion for adolescent idiopathic scoliosis.
  
  
  
  Case report.
  
  
  
  Case report.
  
  
  
  A 15-year-old female presented 21 months after spinal arthrodesis for idiopathic scoliosis with a deep spine infection. The patient had recently been receiving a variation of acupuncture (dry needling therapy) in her medial periscapular region to manage chronic back and shoulder pain. She underwent serial irrigation and debridement with implant removal. Intraoperative cultures revealed pseudomonas and aerobic diptheroids. Two weeks later, the patient developed a periscapular abscess requiring additional operative debridement; cultures from this abscess were negative. After an 8-week course of antibiotics, the patient remains infection free with normalized inflammatory markers 2 years postoperatively.
  
  
  
  Acupuncture is sometimes pursued as part of a multimodality pain management program for back pain, but it is not without risk and can lead to infection. Deep infection from acupuncture may contaminate existing spinal instrumentation and require operative debridement, implant removal, and long-term antibiotic therapy. Accordingly, there is an increased risk for deformity progression in this scenario related to the implant removal.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Hospital, Nashville, TN.
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Callan
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Hospital, Nashville, TN.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bauer
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. Electronic address: jeff.martus@vanderbilt.edu.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Martus
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D000293:Adolescent; D001416:Back Pain / Q000628:therapy*; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion
keywords: Acupuncture; Infection; Posterior spinal fusion; Scoliosis