Document Detail


Management of infection after instrumented posterior spine fusion in pediatric scoliosis.
MedLine Citation:
PMID:  18007254     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Case series retrospective review. OBJECTIVE: To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation. SUMMARY OF BACKGROUND DATA: The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS: The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed. RESULTS: Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I & D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05). CONCLUSION: To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.
Authors:
Christine Ho; David L Skaggs; Jennifer M Weiss; Vernon T Tolo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  32     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-16     Completed Date:  2007-12-19     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2739-44     Citation Subset:  IM    
Affiliation:
Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Bacterial Agents / therapeutic use
Bone Transplantation / statistics & numerical data
Child
Child, Preschool
Debridement*
Humans
Irrigation*
Prevalence
Recurrence / prevention & control
Retrospective Studies
Risk Factors
Scoliosis / epidemiology,  surgery*
Spinal Fusion / instrumentation,  statistics & numerical data*
Staphylococcal Infections / drug therapy,  epidemiology,  prevention & control
Surgical Wound Infection / drug therapy*,  epidemiology*,  prevention & control
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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